AFRICARE - AFRICAN WELL FUND DONATION FORM
 Please print, fill out form and either fax it to Africare at (202) 464-0867 or
mail it to Africare, Attention: African Well Fund, 440 R Street, N.W., Washington, D.C. 20001-1935, USA.
  • DONOR INFORMATION (Provide contact information):
    Name
    Street Address
    City, State and Zip
    Telephone Fax E-mail
  • DONATION (Provide donation amount):
    I would like to help build water wells in dry, needy areas of Africa, through Africare, by making a 100% tax-deductible donation of $ _______________ . (Code U205)

FORM OF PAYMENT (Check one and provide information as requested):
  • Payment by check
    Make check payable to “Africare” and indicate in the Memo/For section that it's for "African Well Fund U205." Check must be drawn on a U.S. bank. Mail check and this completed form to Africare, Attention: African Well Fund, 440 R Street, N.W., Washington, D.C. 20001-1935, USA.
  • Payment by credit card
    Circle one card (Africare does not accept American Express): MasterCard VISA
    Account # Expiration date
    Name as it appears on card
    Signature

Both U.S. and international credit card donations are welcomed.

  • For credit card payments, either fax this completed form to (202) 464-0867 or
  • Mail it to Africare, Attention: African Well Fund, 440 R Street, N.W., Washington, D.C. 20001-1935, USA.
  • If you have any questions, please contact the Africare Development Office at (202) 462-3614 or e-mail Development@africare.org.
Thank you!