The Washington Humane Society

	To make an online donation via credit card, please fill out the following form:

	First Name:
	Last Name:
	Address:
	City:
	State:
	Zip:
	Email:
	Donation Amount:	$25 $35 $50 $100 Other
		Enter Other Amount:
	Direct my gift as follows:

	If the donation is in honor of someone special please enter the person or animal's name*:

	If the donation is in memory of a loved one please enter the person or animal's name*:

	Please provide the following information so we may send a card to the person or animal you are honoring or send a card to the family of the deceased*:
	Name:
	Address:
	Address2:
	City:
	State:
	Zip code:
	Is there anything special about this donation we need to know?

* All donations made in Honor/Memory will be listed in our quarterly newsletter, The Scoop. To help cover the costs of processing and mailing, we ask for a minimum donation of $25 in order to mail a card.