To make a credit card donation by mail, please print this page, provide all the information requested below, sign and date the form, and mail it to:

Rhodesian Ridgeback Rescue, Inc.
PO Box 4141
Leeburg, VA 20177-8287
USA

We accept...
  In US Dollars...MasterCard, VISA, Discover Card, and American Express
  In Canadian Dollars...MasterCard and VISA

Donor/Cardholder Information
Please provide all of the following information.

NAME (Exactly as it appears on card)
ADDRESS (Where your credit card billing statements are mailed)
PHONE		EMAIL
CARD TYPE (Circle One)
MasterCard	VISA	Discover (USA Only)	American Express (USA Only)
CARD NUMBER
AMOUNT OF DONATION	CURRENCY (Circle One)	SECURITY CODE	EXPIRATION DATE
$	US$    CAN$
SIGNATURE OF CARDHOLDER Cardholder agrees to perform the obligations set forth in the Cardholder's agreement with the issuer.			DATE

Donation in Honour or Memory of Someone
If you would like to make a donation in someone's honour or memory, please provide us with the following information. We would be happy to send notification of your contribution:

Please Circle One (if applicable)
I would like my contribution to be a:

   Memorial Donation       Donation in Honour of Someone

HONOUREE'S NAME:

NAME AND ADDRESS FOR NOTIFICATION (If none, please write "None")

Rhodesian Ridgeback Rescue, Inc. is a not-for-profit, charitable organization formed under Section 501(c)(3) of the United States Internal Revenue Code. Donations to Ridgeback Rescue are tax deductible for US taxpayers to the extent allowed by law. If you are unsure whether or not your donation is tax deductible, then please contact a professional tax advisor. To learn more about Ridgeback Rescue, and to obtain a copy of our most recent Annual Report, please visit our About Us page.

STATE DISCLOSURE INFORMATION