Please print this form and mail with your check to:
Holy Family Home and Shelter, Inc.
P.O. Box 884
Willimantic, CT 06226.

I would like to make a donation to the Holy Family Home and Shelter in the amount of $_______________

Name: ____________________________________

Address: ________________________________________

Town: _________________    State:______    Zip:_____________

Telephone Number: _________________________

E-mail: _________________________________________

This donation is made in memory of _______________________________________