V Foundation for Cancer Research

To make a 100 percent tax deductible contribution to The V Foundation, simply complete and submit the form below. If you wish, you may print the form and mail it to us at: The V Foundation for Cancer Research 106 Towerview Court Cary, NC 27513 The V Foundation's Federal Tax ID number or EIN is: 13-3705951. To donate to The V Foundation and receive merchandise, please visit the V Marketplace. V Market Place donations are not 100% tax deductible. Please note: The V Foundation does not share or supply personal information of our donors to anyone for any reason of solicitation or other purposes. For more details view our Privacy Policy, or call us toll free at 1-800-4JimmyV.

BILLING INFORMATION:
Name ( as it appears on your credit card )
Street Address
Street Address (cont.)
City	State
Zip Code	Country
Phone Your phone number is required in the event it is necessary to contact you concerning your donation/credit card information.
Email You will receive an electronic confirmation of your gift. Your e-mail address will not be shared or used for other purposes.

CONTRIBUTION TYPE:

I would like to make a Single Contribution to:

V Foundation
The Garry Betty Foundation
Geno's Cancer Team
Kay Yow/WBCA Cancer Fund

In the following amount:

$1000 $500 $250 $150 $100 $50 $25

Other: $
( include dollar amount only - no $ sign )

I would like to make an Ongoing Contribution to the V Foundation
using the following information:

Amount to contribute:
$1000 $500 $250 $150 $100 $50 $25

Other*: $
( include dollar amount only - no $ sign )
* Minimum recurring donation is $5 per transaction.

I would like to contribute this amount:

I would like the contributions to continue until the following date:
/ /

IN MEMORY/HONOR OF: (this section is not required)
If you would like to make this gift in memory or honor of someone, please complete the following fields: "In memory of" "In honor of"
Name(s)
Comments

Send acknowledgement of this gift to:

Name

Street Address

Street Address (cont)

City

State

Zip

Payment Method:

Visa
Mastercard
American Express

Credit Card Number:

(EX: XXXXXXXXXXXXXXXX )

Exp. Date:

Submit Donation:
*Please press the submit button only once* to ensure proper delivery of your donation.**
If you would like to mail or fax your donation, or contact us: The V Foundation for Cancer Research 106 Towerview Court Cary, NC 27513 Phone: 919-380-9505 (Toll free 1-800-4JimmyV) Fax: 919-380-0025