Verland's Donation Form

Complete and to mail or fax this form to donate directly to Verland or click SUBMIT to contact us via email.

---

Should you wish to support direct support professionals like those depicted in the movie, Riding the Bus with My Sister, click here

1.

The Verland Foundation, Inc. Contributor Code No. 221 212 Iris Road Sewickley, PA 15143-2400 - OR -

2.

The Verland Foundation, Inc. ICF/ORC Contributor Code No. 9180 1511 Hawthorne Street Natrona Heights, PA  15065-1630

3.

Verland Community Living Arrangement Homes (VCLA) Contributor Code No. 126-7208 212 Iris Road Sewickley, PA 15143-2400

How did you hear of Verland?	Event Article DSP cash donation Electronic mail Mail Other Staff TV Website Word of mouth	E-mail Address
Salutation Daytime Telephone Number	Mr. Mrs. Ms. Dr. Required	First Name Last Name	Required Required
Home Address
Address (cont.)		Organization
City
State/Province
Zip/Postal Code
Type of Gift:	Money Adopt a Horse Art DSP cash donation Furniture Office Equipment Computer Equipment Building Land Vehicle Household item(s) Bequest Stock Insurance policy Will Trust Other
Amount of Gift:

THANK YOU FOR YOUR CONTRIBUTION. Please provide any additional information you feel will be helpful.

Select any of the following options that apply:

Bill Me	Credit Card Credit Card Company: Number Expiration Date Signature:
Call us at 412-741-2578 to provide credit card information

To send via United States mail , via fax to (412) 741-2350 or for credit card authorization,
please print, sign and mail this form to Verland.

Click below to submit to Verland via email.