Helen verDuin
Palit, D.H.L
Founder and President
America Harvest, Inc.
(AngelHarvest.org)
4045 Sheridan Ave. #226
Miami Beach, FL 33140
213-280-0585 (Tel)
786-206-3476 (Fax)
americaharvest.org
hpalit@angelharvest.org
Please take a few moments to complete the
form below. Your email address is required, but
all other fields are optional, so feel free to provide as much or as little information as
you like. If you prefer to fashion your own email, simply click here.
|
AREAS OF INTEREST
please check all that apply
|
CONTRIBUTING MONEY
Corporate Matching Gifts
Regular Recurring Gifts
Bequests
DONATING SECURITIES
OTHER
|
CONTACT INFORMATION
|
|
Name: |
Example: 'John Smith' |
|
E-Mail Address: |
Example: 'johnsmith@aol.com' |
|
E-Mail Confirm: |
Example: 'johnsmith@aol.com' |
Telephone
Area Code: |
Example: '213' |
Telephone
Number: |
Example: '555-1212' |
|
When to Call: |
|
|
Title: |
Example: 'President and CEO' |
|
Organization: |
Example: 'Smith Services, Inc.' |
|
Street Address: |
Example: '123 Main Street' |
|
|
Example: 'Suite 456' |
|
City: |
Example: 'Beverly Hills' |
|
State: |
|
|
Zip Code: |
-
Example: '90210-1010' |
|
Country: |
|
|
Website Address: |
Example: 'http://www.SmithServices.com' |
OPTIONAL MESSAGE
|
|
Subject: |
Example: 'I am interested in...' |
|
Message Text: |
Example: 'I am ... I have ... How can I ...'
|
