House of Mercy Online Donation Receipt
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Name
First Name
Last Name
Email
Verify Email
Phone
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Can we add you to our email list?
Yes
No
Can we add you to our postal mailing list?
Yes
No
Is this a goods or food donation?
Goods
Food
Pounds
Enter # of pounds for food donation if needed for receipt.
Items Donated
*
If you have a long list, you may attach it to a printed copy of your email receipt for tax purposes, just add "See List" to the field above.