Please print this form, and send it with your donation.
Your donation to ORCCA is greatly appreciated.
Please print this form and mail it with your donation payable to:
Please print this form and mail it with your donation payable to:
Oregon Coast Community Action
2110 Newmark Ave. Coos Bay, OR 97420
2110 Newmark Ave. Coos Bay, OR 97420
Please accept my enclosed donation of ( )$10 ( )$25 ( )$50 ( )$100 ( )$250 ( )$________
Towards the following:
| ( ) General Fund | ( ) Housing Assistance |
| ( ) Development of Programs | ( ) Energy Assistance for Needy Families |
| ( ) Med Net / Medical Programs | ( ) Energy Saving Items/Devices |
| ( ) Self-Sufficiency Programs | ( ) Energy Education |
| ( ) South Coast Food Share | ( ) Coos County CASA |
| ( ) South Coast Food Share – Snack Pack | ( ) South Coast Head Start |
| ( ) South Coast Food Share – Food only | ( ) ORCCA Campus |
| ( ) Great Afternoons in Reedsport | ( ) Other ____________________ |
Donor Information:
Name
Address
City, State, ZIP
Phone (optional)
Email (optional)
( ) I would like someone to contact me for more information.
Donations to Oregon Coast Community Action are tax deductible to the extent allowed by law. ORCCA DOES NOT release your personal information to any other organizations without your prior written permission. Tax ID # 93-0547036
