PRINT OUT this form and send it along with your check or money order directly to: Refuge Farms, Inc. Donations & Support Donation P.O. Box 195 Spring Valley, WI 54767

[PLEASE PRINT]

Donation Date:
Name:
Street Address(1):
Address(2):
City:
State:
Zip Code:
Telephone Number:
Email Address:

Please note any specific use or request(s) regarding your Donations & Support Donation...Thank you !!!
DO NOT SEND CASH - Check or Money Order only. TOTAL ENCLOSED	$
Please make check or money order payable to Refuge Farms, Inc.

If this is a gift donation, please fill in the information requested below:

Gift Given By:
To Honor:
Message: