HLHAS GREATLY APPRECIATES ALL DONATIONS.  PLEASE  PRINT OUT THIS FORM, COMPLETE INFORMATION AND MAIL TO:

HI-LINE'S HELP FOR ABUSED SPOUSES

300 N. VIRGINIA SUITE 307

CONRAD, MT 59425

 

                 I wish to remain anonymous

 

NAME:

 

ADDRESS:

 

CITY, STATE, ZIP:     

 

I WOULD LIKE TO DONATE : PLEASE SPECIFY AMOUT:   $

 

I WOULD LIKE MY DONATION TO GO TO:

              Victim services

                 Where it is needed most

                 Other please specify: 

 

 

                

PLEASE SPECIFY: