Please print and complete the following information**:


            Amount Donated: $______________    Date: _____________________


            Your Name: ________________________________________________


            Your Address

                        Street: ______________________________________________


                        City:    ______________________________________________


                        State:  ______________________________________________


                        Zip:     _______________


            Your Telephone Number: ______________________________


            Your Email Address: __________________________________


            Are you interested in donating:

                        Your time and labor ______________________________?

                        Materials or equipment____________________________?



**The above information is necessary to ensure that you will receive a receipt for your donation.  Please make your check payable to:

Highland Rim Habitat for Humanity

(a registered 501(c)(3) organization).


Please send your check or money order to:


Highland Rim HFH

P.O. Box 1295

Tullahoma, TN  37388