Home
Services
Success Stories
Donation
Pledge Form
Thank you for your interest in making a donation to Bernie Lorenz Recovery! Please use the following form to provide information about your donation.
If you would like to make a financial contribution to Bernie Lorenz Recovery, please print and mail in our
Pledge Form
. Please print a copy for your tax records using the print button in your browser toolbar.
If you would like to donate goods for our home, please refer to the list of
items needed
.
Date:
Name:
Email Address
Address
Phone:
Home
Other
Work
Fax:
Donation Type:
Description:
Estimated Value:
When we receive this information, we will contact you with instructions necessary to complete your donation.
Contact Information
© 2005
Bernie Lorenz Recovery
Updated: 7/14/07
