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PRINTABLE DONATION FORM

Mail or fax to:
Blue Mountain Heart to Heart
P.O. Box
40
2330 Eastgate Street, Suite 105

Walla Walla, Washington 99362
 

$10
$25
$50
$100
$_______Other

Please supply your credit card and/or contact information

Cardholder Name______________________
Billing Address________________________
City_________________________________
State________________________________
Zip or Postal Code_____________
Phone Number ________________________

Card type: __American Express __Mastercard __Visa __Discover __Other

Card Number ________________________________________

Expiration Date ______________________

Signature____________________________________________
 

A receipt will be mailed to you within 10 business days!

We sincerely thank you for supporting Blue Mountain Heart to Heart.

 
   

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info@bluemountainheart.org | (509) 529-4744 or 1-888-875-2233 pin:4744