One Time Donation via Debit to

Your Checking Account

**You must have a Check Card with a Visa or MasterCard logo on it to use this option.

If you prefer, you can print this page, complete the form, and mail it to us. If you

choose this option, you must sign your name where indicated below. The form

should be mailed to:

Feed Washington

8435 161st Ave. NE

Redmond, WA 98052

To process your donation on-line, please provide the information requested

below:

Required Information **

Name**

Organization

Street Address (Where your monthly bank statement is mailed)**

City** State** Zip Code**

Phone**

**Your phone number will never be given to anyone for any reason. We require it only

so we can contact you if there is a problem in the processing of your donation.

Email Address**

Type of Check Card**

Amount of Your

Donation** Will your employer match your donation?

$ (No Minimum)

Check Card Number** Expiration Date**

Please sign here if you are mailing us this form:

___________________________________

We would love to recognize your generosity by adding your name to the

donor list published on our website. If you would like to be recognized on

our Corporate Donor list, please include your corporation's name above.

Yes, please include my name on the donor list.

No, I would prefer not to be recognized.

How did you hear about us? Comments?