License No.	______________________________
Donation Form
	Please Print Clearly		Donations due by march 1st
*	DATE:  ______________		Suggested Retail Value: ______________
*		OR	Check Number: ____________			Check Amount: ____________
		OR	VISA/MC Number: _______________________ Exp: _____/___
*	DONATION OF:	_______________________________
*	DONOR NAME:	_______________________________
*	ADDRESS:	_________________________________________
*	CITY:	______________			ST.	___	ZIP:	___
*	PHONE NO.	(       )				email:	__________________
	Website: if available)	______________________________
	Your FEDERAL TAX ID NUMBER:	(if available)		__________________________
	SPECIAL INSTRUCTIONS:	________________________________
	Hockey Affiliation - if any	________________________________________________________________
	Your HHH Contact :	_______________________________________________________________
	Directions for Donation Form:
1)	-Completely fill out the above form.
2)	-Make Checks payable to Hockey has Heart
3)	-Mail to: Hockey Has Heart 35500 Eight Mile Rd. Farmington Hills, MI. 48335
OR	-If you received this electronically you can complete & then email it back to HockeyHasHeart@aol.com
OR	-If you are using a credit card you can fax to my home office at 248-478-9177
4)	-A confirmation receipt of the donation will be sent directly to the donor.
*	Required fields	Indicate One			Office Only
		Donation Received			Donation form complete
		Donation to be Delivered			Form delivered to HHH office
		Donation to be Picked Up by			___________________________