Please print this form and complete the information below to ensure proper preparation of your tax receipt (please print
clearly). To donate to a specific cause, please write the name of the cause on the memo line of your check.
If you would like to donate by phone via credit card, please call 1-800-HELP NOW (1-800-435-7669).
Today’s Date: ________________________________________________________________
Amount of Check: $_________________________________ payable to American Red Cross.
Donor Name: _________________________________________________________________
Organization Name (if applicable): ________________________________________________
City: _____________________________ State: ____________________ Zip Code: ________
Email: (optional) ______________________________________________________________
Telephone Number: (optional)__________________________________ □ Home □ Mobile
□ Yes, you may contact me via phone with future disaster alerts, preparedness tips, and other ways to get involved in the Red Cross.
Please mark with an “x” your desired cause. This will enable us to apply your donation where you intend.
□ Where It Is Needed Most: Support all of the urgent humanitarian needs of the American Red Cross.
□ Disaster Relief: Help people affected by disasters big and small.
□ Your Local Red Cross: Provide for local Red Cross programs and services in your community.
□ Other* (please specify): _________________________________________________________________
Please also indicate the name of the specific cause on the memo line of your check.
*For Other Causes: If the American Red Cross is not raising funds for the specific cause you have
indicated and/or donations exceed American Red Cross expenses for that specific cause, please
indicate how you would like us to handle your gift (please select one option below):
Please apply my donation to Disaster Relief to help people affected by disasters big and small.
Please return my check.
Your questions and feedback are very important to us. Please feel free to contact us at redcross.org
or call 1-800-RED CROSS (1-800-733-2767). Thank you for your support.
Rev. 1/2017 RSG00000MCDF
Please mail this completed form to:
American Red Cross
PO Box 37839
Boone, Iowa 50037-0839