Unity : Memorial Gift Form

Please complete the gift form below. Don’t forget to print the form and either mail or fax the form to the address or fax number found at the bottom of this page.

1. My Gift

My gift of

I would like to
designate to

I want my gift to go toward:

2. If made in Honor or in Memory

In Honor of or In Memory of	(Full Name)
Name
Address
Address 2
City
Please Select a State		Zip/Postal Code
Country

3. Please Send an Acknowledgement of My Donation to

Name
Address
Address 2
City
Please Select a State		Zip/Postal Code
Country

4. My Information

Name
Address
Address 2
City
Please Select a State		Zip/Postal Code
Country
E-mail Address
Telephone

4. Gift Options

Either Check/Money Order

* Please enclose Check/Money Order, and see instructions below

Or Credit Card

Visa	MasterCard
Discover	American Express

Please charge my
credit card the gift amount

One Time

Monthly

Account #

Expiration Date

Name on Card

Signature

NOTE: Please sign within the area to the right on the printed copy of the form
before mailing or faxing it to Unity.

Thank you for filling out this information. Please print it out and send via:

Mail:
Unity
1901 NW Blue Parkway
Unity Village, MO 64065-0001

Fax:
816-251-3554

* Please make all checks and money orders payable to “Unity.”

All gifts to Unity are tax-deductible.
God bless you and thank you for your support!