Donation Certificate Form

Instructions:

Please fill out the following sections completely. We will custom print each certificate using the information you provide. The donor section should contain information about you. In the recipient section, please provide information about the individual you wish to give this certificate. Should you have questions regarding formatting or information placement, please see the Donation Certificate image or e-mail Heather Bowden.

Donation Certificates can be issued in any amount (over $5).

Information about the Donor:

Contact Name:
Street Address:
City:
State:
Postal/Zip Code:
Country:
E-mail:

To show our appreciation to all our supporters, we list donor's names on our LABMED Donors Page. Please check the following radio button if you would like to have your name included.

Please include my name on the LABMED Donors Page.

If you would like your entry to be different than the contact name above, please use the following text field to tell us:

Payment Method?
I will send a Check to the address provided below;
I will send a Money Order to the address provided below;
I will provide my Visa/MasterCard information by calling the phone number provided below;
I will use PayPal via the link provided below.

Donation Certificate Recipient:

Name (to Appear on Certificate):
Street Address:
City:
State:
Postal/Zip Code:
Amount:
E-mail:
Donation Made By:

Comments?

The information provided in the Donation Certificate Section will be used to create and send a custom printed certificate to the above named individual(s). A formal Donation Letter will be sent to you utilizing the contact information you provided in the Donator Section. This donation letter will include the donation date, amount donated, and our Federal Tax Number. Please remember that all donations are tax-deductible and are very much appreciated. If you would like to include a personalized phrase, please feel free to do so in the Comments box in the section above.

To complete your request:

Please fill out this form completely, including your e-mail address. The requested information will allow us to contact you in the event of questions concerning your certificate order.

Visa Logo MasterCard Logo When your check or money order arrives we will ship your certificate. To pay by credit card, fill out and submit the order form to process your request. Then call 972-208-2470 between the hours of 8AM - 8PM CST to supply your credit card information.

If you wish to pay via PayPal - please process the order form and then pay vi a our PayPal Information Page.

If you wish to pay by check or money order, when your form is complete, please submit it (you may wish to print a copy for your records) and mail a copy, along with your check or money order, payable to LABMED, to:

LABMED, Inc.
3941 Legacy Drive, Suite 204, #A115
Plano, TX 75023

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Last Updated: Fall 2015