Donations Form

This form is for donating to St. Anthony’s Padua Dining Room by cash or check.
It also provides for donating in memory or honor of someone.

Please print the form, complete, enclose it with your donation and mail it to
St. Anthony’s Padua Dining Room
3500 Middlefield Road, Menlo Park, CA 94025-3099.

Please complete the information below and check boxes (  ) as needed:

First Name: ______________________ Last Name_____________________________

Home Address_________________________________________________________________

City: ___________________________________ State__________ Zip: ______________

Phone: _____________________E-mail: _______________________________________

(  )   I would like to make a donation of: _________________________________________

(  )   I would like to make a monthly pledge of: ____________________________________

(  )   I would like this donation to be used for: ________________________________________________________________________

(  )   I would like this donation to be in honor of: memory of: ________________________________________________________________________

Additional memory/Honor information if required: ________________________________________________________________________
________________________________________________________________________

(  ) Please send card to:                                                           (  )  No card needed.

Name: _________________________________________________________________

Address: _______________________________________________________________

City: _________________________________ State__________ Zip: _______________

You and the individual(s) named above will receive separate acknowledgements.
Your dollar amount will not be indicated on their acknowledgement.

Check Amount:

(  )  $100     (  )  $250     (  )  $500     (  )  $1,000     (  )  $5,000     Other: _____________.

Comments:_____________________________________________________________
______________________________________________________________________

Gifts to St. Anthony’s Padua Dining Room are tax deductible as permitted by law.
Tax ID #94-3151091. If you need more information, please call
Max Torres, Operations Manager: (650) 365-9664

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