Mail-In or Fax Donation Form for
Community & Senior Services of Midland, Inc.
We gratefully appreciate each and every gift. Your generosity brings nutritious meals,
compassionate visits and services to the homebound elderly and disabled in Midland.
Enclosed is my tax-deductible gift of $___________ to be used for
q Meals-on-Wheels q Homebound Services q Endowment Fund q Operating Fund
Name _________________________________________________ Phone __________________
Address __________________________ City ___________________ State ____ Zip _________
q Visa q MasterCard Number _________________________ Expiration Date ___/___/___
Signature _______________________________________________
Memorial or Special Gift
This gift is made q in honor of or q in memory of
_________________________________________
Please send acknowledgment to:
Name _________________________________________________ Phone __________________
Address __________________________ City ___________________ State ____ Zip _________
(The amount of the gift shall remain confidential.)
As they depend on us -- We depend on you!
Please mail or fax to:
- Community and Senior Services
- 3301 Sinclair Avenue
- Midland, TX 79707-6620
- Phone No. (432) 689-6693
- Fax No. (432) 689-6699
