Counseling & Recovery Center, Inc.

Donation Form

Donor Information:

Name ___________________________________________
Address _________________________________________
City _______________________________________
State ________________________ Zip ___________
Phone Home (_____) __________________________
Work (_____) __________________________
Email ___________________________________________

Amount of Gift:

$5,000 $2,500 $1,000 $500
$365 (dollar a day) $250 $100
$50 Other $ ___________

You could double your donation.

Please check with your employer's human resources department for matching gift
opportunities and send their form with your donation.

Please send your gift, along with this form to the following address:

Counseling & Recover Center, Inc.
4753 Orange Avenue
Ft. Pierce, FL 34947

Thank you for your support and kindness!

Counseling & Recovery Center, Inc. is licensed in accordance with Chapter 397, Florida Statutes to provide substance abuse service for ADULTS ONLY for the following component(s): Day/Night, Outpatient, Aftercare, Intervention, Prevention, and Residential Level IV Programs. License Number 15-56-AD-8051-01

We are a Non-profit, 501(c)(3) Organization(Verification # 1-877-829-5500)
© 2004 Counseling & Recovery Center. All rights reserved.