166 Station Rd., Bernville, PA  19506 / Phone: 610-621-5290/ Fax: 610-621-5299
A Nationwide Community non Profit 501(c)(3) Organization (Non Profit Tax ID# 20-0285993) - Donations are tax deductible.

                                                                                             Charitable Donation Form

Your tax-deductible gift will support the mission of Another Chance 4 Horses, Inc. equine rescue, placement and intensive care rehabilitation.  Thank you.

This gift is from:  (Please Print)

Name(s):  ____________________________________________________________________

Street:  ______________________________________________________________________

City, State, Zip  _________________________________ Telephone:  ____________________

                                                                                           (In case we have questions regarding our gift)

This gift is    _____  in honor of           _______  in memory of

Please print name here (honor or memory of)_______________________________________

I hereby authorize Another Chance 4 Horses, Inc., located in Pennsylvania to bill the following credit card number in the amount of $                                 Please also write the amount:           

Credit Card Information, Type of Card:                                  Account Number:

Security Code (three digit number located on the back of the card)                        Expiration Date:

Name of Card Holder:

Address of card holder:

Email address:                                                                  Telephone number:

Signature of Cardholder                                                   Date: 

Questions?  Call 610-621-5290 or email info@ac4h.com