Donations Page

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Donation Form - Mail/Fax

Please help support the Pennsylvania Council on Independent Living (PCIL) by printing out and completing this donation form, and returning it to us by mail or fax to:

Pennsylvania Council on Independent Living
101 South Second Street
Suite 4
Harrisburg, PA 17101
Fax: (717) 920-0532

If you have any questions we would be happy to provide you with more information regarding PCIL and the services that are provided through our organization.

Thanking you in advance for your support.

Donation Form
Yes, I want to support the Pennsylvania Council on Independent Living
Name: Company (if applicable): Address: City: __________________________________ State:_______ Postal Code: ______________
Country : Postcode (if not USA):
Telephone number:
E-mail:

Please make check or money order payable to: Pennsylvania Council on Independent Living
I have enclosed a contribution in the amount of US$ __________ Money Order Check
Check here if you would like acknowledgement of receipt of donation via email

The Pennsylvania Council on Independent Living (PCIL) is a tax-exempt 501(c)3 organization. All donation are tax-exempt. Contact us if you require a receipt. For further information, please use our Feedback form. Mail completed donation form to: Pennsylvania Council on Independent Living 101 South Second Street Suite 4 Harrisburg, PA 17011 FAX: 717-920-0532 Thank you for your contribution!

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