Donation and Giving Form

The Mental Health Association in Texas offers most of its resources and materials at no cost to individuals, organizations and businesses.

We recognize that there are sometimes special opportunities or needs that a community may have and our resources are limited.

For just this reason, we solicit the support of donors and grantmakers. There are many ways to make a tax-deductible gift to the Mental Health Association in Texas. Below are several options.

Please complete this Donation and Giving Form and return it along with your contribution to:

q Mental Health Association in Texas
q 1210 San Antonio, Ste. 200
q Austin, Texas 78701

For more assistance, please call 512-454-3706 or mhainfo@mhatexas.org.

q I would like to support the Mental Health Association in
q Texas with my tax-deductible gift of:

q $5000	q $2500	q $1500
q $1000	q $750	q $500
q $250	q $100	q Other______

Name ______________________________________________

Address_____________________________________________

City_______________________ State:____ Zip:_____________

Daytime Phone: (_______)______________________________

Email:______________________________________________

Fax Number:_________________________________________

Payment Type:

q Check	q Credit Card
Visa / MC / Disc Exp.Date _ _ -_ _ _ _ _ _
CC# _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Donation Type:

q Gift of Cash	q Memorial Gifts	q Planned Gifts
q Corporate Matching Gifts q Company or Organization Name____________________________________

In Honor of:
_______________________________________

In Memory of:
_______________________________________