
To donate to Agnon by mail, fax, or email, print this form and
Mail to: Agnon School, 26500 Shaker Boulevard, Beachwood, OH 44122
OR
Fax to: 216-464-3229
OR
Fill in and e-mail info to: Lleventhal@agnon.org
I wish to donate $________.
Name:_______________________________________________________________________
(Indicate how it should appear in the Annual Report)
____ I wish to contribute anonymously.
Address: _____________________________________________________________________
City, State, Zip: _______________________________________________________________
Daytime phone (in case of questions) E-mail:
(_____)-_____________________________ ______________________________________
Payment Method:
____ Check made payable to Agnon School
____ Charge my gift to:
____ Visa ____Master Card ____American Express
Credit Card Number: __________________________________________________
Exp. Date: ____/____ Signature: _______________________________________
Security Code on Back of Card: ___________________
Optional
This gift is being made ____ In honor of ____In memory of
________________________________________________________________________
Special occasion to be acknowledged:
___ Birthday ___Aniversary ___Get Well ___Wedding ___Birth of Child
___ Staff Recognition ___Other _________________________________________
Please send an acknowledgement of my gift to:
Name: __________________________________________________________________
Address: ________________________________________________________________
City, State, Zip: _________________________________________________________
Thank you for your generosity and support. As a 501() (3) organization, all contributions are tax deductible to the extent allowed by law.


