Thank you for your generosity! Please print and complete this form. Mail the form along with your check, payable to Jersey Animal Coalition, to the following address: Jersey Animal Coalition, 298 Walton Ave., South Orange, NJ. 07079 Name_________________________________________________________________ Address_______________________________________________________________ City___________________________________State_________________Zip________ Telephone – Home______________________________Work____________________ Enclosed is my tax-deductible cash contribution: ____$25 ____$50 ____$100 ____$250 ____$500 ____$1000 _____Other Please apply my donation to the following JAC fund: ____No preference ____Gimmeeshelter Campaign ____Lurie/Peabody Fund ____Beauty Fund ____Guardian Angel