Donor / Sponsorship Form
 
FUSE, Inc.
P.O. Box 314
Greenfield, IN 46140
(317) 462-9064
 
 
 
 
 
 
 
 
 
 
 
 

 

Help make a difference for families raising children with special needs! For your convenience, several giving options are available so you can choose what fits best in your budget. Remember all donations to FUSE are tax deductible. Thank you very much for supporting FUSE!

Please complete the following:  

Your name:
Your email address:

Your phone number:

Address:
       
   
City
State
Zip
   

Monthly Pledge:

I would like to pledge a donation of
per month.
Please charge this monthly amount to my Visa or MasterCard. I will provide the card information when FUSE calls me to follow-up this transaction. 
Please debit this amount from my checking account. I will be sending a voided check or deposit slip to FUSE.
Please send me a monthly invoice (minimum $25 per month for invoice option) 

One Time Donation:

I would like to donate to FUSE:
$ 25.00
$ 50.00
$100.00
$250.00
$500.00
Other
Please charge this one time amount to my Visa or MasterCard. I will provide the card information when FUSE calls me to follow-up this transaction. 
Please debit this amount from my checking account. I will be sending a voided check or deposit slip to FUSE.
I am sending my personal check to FUSE.

After completing this donation form, please print it as your confirmation of your intent to donate to FUSE before you SUBMIT below.