Wesley Community Services Gift Form - Wesley Community Services : We Care For Seniors. Based in Cincinnati, Ohio.

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By Telephone/Fax
Phone: 513-661-2777
Fax: 513-389-3092

By Postal Mail
Wesley Community Services
2091 Radcliff Drive
Cincinnati, Ohio 45204

Wesley Community Services Gift Form

Gift Giving Instructions

To make your gift or pledge to Wesley Community Services, please complete the attached form and the Wesley Community Services Development Office will take care of all the rest. For questions please contact our Development Office at 513-389-3096. Thank you in advance for your thoughtfulness.

Name: *

Address: *

City: * State*: Zip*:

Home Phone:

Business Phone:

Fax:

Email: *

My gift of $ will be paid:

Online by Credit Card
Enclosed
Please contact me regarding a planned gift and/or bequest.

I would like to designate my gift to -

$ Meals-On-Wheels ($6.10/meal, $42.70/week, $8 therapeutic meal, $56/week)
$ Medical Transportation ($25 1-way, $30 1-way wheelchair assist)
$ Housecleaning and Supplies ($24 for 1 hour, $48 for 2 hours)
$ Pet Portions Program
$ PetKare Program
$ Other (please specify)

I would like to make my gift in memory of / in honor of -

In Memory of:
Relation:

In Honor of:
Relation:

Please send a sympathy / honorarium card to -

Name:
Address:
City/State/Zip:	State: Zip:

Message to appear on card -

Please send information to me about Wesley Community Services (check all that apply)
Home Care Services
Meals-On-Wheels
Medical Transportation
Pet Portions Program
PetKare Program

Please Retype the Security Code*:

All fields marked with * are required.

If you are paying your gift by credit card select "Email My Gift Response Form" and then select "PayPal" for payment arrangements. If you are paying your gift by mail please print this form once completed and mail along with your check to Wesley Community Services, Attention: Development Office, 2091 Radcliff Drive, Cincinnati, Ohio 45204. For assistance call our Development Office at 513/661-2777.


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