Thank you for supporting the work of House In The Wood!  
Please print this form and mail, fax or email it with your gift to the above address. 
If your employer offers a Matching Gift program, please ask your human resources department for the appropriate form and mail it along with your gift.

Yes!  I want to make a one-time gift:

 $2,500    $1,000    $500     $250    $100    $50    Other ___________

Yes!  I want to make a monthly recurring gift  via credit card  via bank account:    

  $100      $75       $50       $25      $15       Other ­­­­­­_____________

Name: _____________________________________________________________________________
Address:  ___________________________________________________________________________
City, State, Zip:  _____________________________________________________________________
Day phone:  (_______)_______________________ Email address: ____________________________

Please use my   Visa   Master Card    Discover Card   ++

Number:  _______________________________________________   Expiration Date: ____________

Please use my   checking   savings account: **
Banking Institution:  _________________________________________________________________
Account Number:  ___________________________________________________________________
Routing Number:  ___________________________________________________________________

I would like to give my gift  in Memory of /  in Honor of:

Name/Occasion ____________________________________________________________________

Please send notification of my gift to:

Name _____________________________________________________________________________
Address ___________________________________________________________________________
City __________________________________ State ____________ Zip _______________________

++ Charges will appear on your statement as Northwestern University Settlement.
** Providing this information constitutes permission for ACH withdrawl.