KELLER COMMUNITY SENIOR FUND, INC.

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A 501(C)(3) NONPROFIT ORGANIZATION DONATION

Email *

PAYMENT METHOD: *

PAYPAL

DEBIT OR CREDIT CARD

Last Name, First Name *

Street, City, State, Zip *

Valid Phone Number *

Preferred contact method *

Mail

Phone

How did you hear about us? *

Keller Senior Center

KCSF Board Member

Keller Chamber

Advertising

Other:

ENTER YOUR DONATION AMOUNT WITH NUMBERS ONLY (do NOT include $ sign) Must enter 0 = ZERO for EACH area where NO $ is intended

GENERAL FUND - $ *

FUNDRAISERS - $ *

MEALS PROGRAMS - $ *

DONOR WALL - $ *

ENTER INFORMATION TO BE ENGRAVED FOR DONOR WALL ONLY

I AM MAKING THIS GIFT:

In Memory of

In Honor of

NAME OF PERSON TO RECOGNIZE

PLEASE ENTER NAME AND COMPLETE ADDRESS (Street, City, State, Zip) OF PERSON TO RECEIVE ACKNOWLEDGEMENT OF YOUR GIFT IF DESIRED.

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