Single or Monthly Gift Form
914-961-8313 ext. 317
575 Scarsdale Road
Yonkers, NY 10707
Attention: Advancement Department
I would like to donate the amount of $_________ Circle one: Monthly Single
Donating by Check
Please mail your check to the address above.
If donating by Credit Card, please provide us with the following information:
Circle one: VISA Master Card American Express Discover
Credit Card Number: _______________________________Exp. Date: __________
Name on the Card: ____________________________3-digit Security Code: _____
Please provide the following information in full.
Circle Your Preferred Title: Ms. Mrs. Mr. Dr. Other: ____________________
First Name: _____________________________ Last Name: _________________
Preferred Name: _________________________
Mailing Address: _____________________________________ Apt. __________
City: _______________________ State: ______________ Zip Code: ___________
Country: __________________ Email: __________________________________
Daytime Phone: ___________________Evening Phone: _____________________
Email Address:
My gift is: (Circle one) in Honor/in Memory of _____________________________
Check any that apply:
_____ Yes, I prefer to “go green” and receive email rather than standard mail
____Yes, please send me the latest SVS Annual Report!
_____ I do not want to receive email
Source Code: 2017 Web Form