...DONATION AND GIVING FORM


Please print and then fill out the following form and submit it with your personal check or money order to:

Mental Health Association in Texas
1210 San Antonio Street
Austin, Texas 78701
Phone: 512-454-3706
Fax: 512-454-3725 fax
Email: mhainfo@mhatexas.org

I would like to support the Mental Health Association in Texas with my tax-deductible gift of:

____ $25 _______ $50 _____ $75__ _____ $100
____ $250 ______ $500 ____ $1000 _____ OTHER



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Your Name*:
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Company Name*:
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Address*:

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City*:

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State*:
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Zip*:
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Telephone:
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Fax:
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E-mail*:


PAYMENT TYPE


___ Check

___ Credit Card____ __Visa __MC __Disc __AMEX

CC# __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp. Date___________________

Signature________________________________________________________________



DONATION TYPE



_____ GIFT OF CASH

_____ CORPORATE MATCHING GIFTS:________________________________________________
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Company or Organization Name
_____ PLANNED GIFTS

_____ MEMORIAL GIFTS:____ In Honor of ______________________________________________
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_________________________In Memory of_____________________________________________
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The Mental Health Association in Texas is a non-profit 501(c)(3)organization.
All contributions are tax-deductible.