L.A. CADA

P.O. Box 3205

11015 Bloomfield Ave

Santa Fe Springs, CA 90670

DONOR INFORMATION

Name: ______________________________________________

Address: ____________________________________________

City: _______________________________________________

State: ________________ Zip: __________________________

E-Mail Address:_______________________________________

PLEASE INDICATE:

Enclosed is my check for $_________

Please charge my gift of $_________

Visa / Master Card

Account No. ___________________________________

Exp. Date ___________

Signature _____________________________________

Phone Number ________________________________

Please Apply My Gift to the:

General Fund_____ Allen House Building Fund______ FFP Fund______

Please make checks payable to: L.A. CADA ( Los Angeles Centers for Alcohol and Drug Abuse).

All gifts are tax-deductible. For your records our tax ID # is: 23-711052.