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