The purpose of the West Hollywood Recovery Center Capital Campaign Fund is to secure a permanent location for the WHRC providing assistance with addiction recovery, prevention and education to those in need. Your contribution is greatly appreciated and is tax deductible.
                        WHRC is a 501(c)3 non-profit organization.
                           Our tax identification # is: 04-3614548


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Donor #1		 _____________________________________________
Donor #2 (If you wish to be acknowledged as a couple)
   
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Address		 _____________________________________________
City / State / Zip
   
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Phone		 _____________________________________________
 Email Address
   
Payment Options:      All at once      Quarterly      Monthly
Donors choosing to fulfill their pledge quarterly or monthly are requested to provide credit card information so we may process your pledge in a timely manner.
   
Payment Type:   Check Enclosed     Charge My: Visa     Mastercard
   
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Card Number		 ____________
Exp Date		 _________________________________
Name on Card
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Billing Address (if different from above)
   
For donors making their pledge by credit card and/or by quarterly or monthly payments please fill in the amount of your pledge, date and sign the following:
 
My signature hereby acknowledges the amount of $___________as an annual commitment to WHRC beginning on ___________ and ending one year from that date.

Today's Date:________________________ Signature:_______________________________
   
Please return this form with your payment to:
 
West Hollywood Recovery Center Capital Campaign Fund
8391 Beverly Boulevard # 345
Los Angeles, CA 90048
   

_________________________________________________________________ Office use only.