Great Valley Center Donation Form
Thank you for considering including the Great Valley Center as part of your charitable giving. Please print this form and include it with your contribution.
Personal Information
First & Last Name:
Address:
City / State / Zip Code:
Home Phone:
Business Phone:
Fax:
E-mail:
Payment Options
Donation by Check
 Mail Your Contribution – Make Check Payable to:
Great Valley Center
201 Needham Street
Modesto, CA 95354
OR  
Donation by Credit Card Credit Card Donations may be faxed to 209/522-5116. Please fill out the credit card information below.
Amount $
Please use my: VISA      MASTERCARD

AMERICAN EXPRESS      DISCOVER
Card Number
(1234 2345 1234 1234)
Name (as it appears on card)
Expiration Date: (MM / YY) /

Great Valley Center
Nonprofit Tax ID: 77-0450770