Brighten A Life Honor Memory Donation Form

Order Form:

Note: If you have more than one Memorial or Honorarium, this form may be duplicated. Make check payable to: SWVA Second Harvest Food Bank Brighten A Life Mail to: 1025 Electric Rd. Salem, VA 24153. Please send Thank-you card to:

Donor's Name (s):____________________________________________________Phone:______________________________

Address:________________________________________________City:____________________State:_______Zip:__________ My donation of $_________to SWVA Second Harvest Food Bank is enclosed. ___ In Memory of Name:_______________________________________ ___ In Honor of Name:_______________________________________

Please send Gift Notification Card to: (one card per donation please) Name (s):_________________________________________________________Phone:_________________________

Address:________________________________________________City:____________________State:_______Zip:__________