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Get Children With Hair Loss Hair Donation

Please send this completed form along with your hair donation to Children With Hair Loss 12776 Dixie Hwy S. Rockwood MI 48179 Print Clearly Name of Donor Email Phone Please provide your Email allowing us to send your certificate faster save money and help more kids International donors receive certificate by Email Street Address Apt/Suite City State/Province/Region Zip/Postal Code Country A certificate of appreciation will be e-mailed or mailed to you. HAIR DONATION Hair must be a minimum of 8 inches clean DRY and in a ponytail OR braid* Place your hair donation into a zip lock bag and then in any mailing envelope. Please allow up to 6 weeks to receive your certificate and t-shirt. Please print my certificate In Memory/Honor Of Have you donated to us in the past Did you include a picture Find us on Facebook Any Comments Do we have your permission to publish it Facebook. com/CWHLMI Twitter Signature Twitter. com/cwhlorg and send us a photo and/or comment We appreciate your HAIR DONATION but there is still a HUGE COST to have a hair replacement made. Could you please consider contributing a tax deductible donation TODAY I HAVE ENCLOSED A DONATION TO HELP PAY FOR A CHILD S HAIR REPLACEMENT SIZE Youth Medium Fits up to child size 8 Adult SM MD COLOR Select One LG XL Youth Large Fits up to childe size 14 XXL Black Shirt w/White Writing YOU CAN SEE THE T-SHIRTS ON OUR WEBSITE XXXXL Pink Shirt w/Black Writing If you live outside the United States your order must be placed through our website www. ChildrenWithHairLoss. us Checks may be made payable to Children With Hair Loss To have your donation charged to your credit card please fill in your information below Payment Type Visa Master Card Discover American Express Credit Card Number Exp Date Name as it appears on card 3 Digit Code on Back Signature of Cardholder. Please allow up to 6 weeks to receive your certificate and t-shirt. Please print my certificate In Memory/Honor Of Have you donated to us in the past Did you include a picture Find us on Facebook Any Comments Do we have your permission to publish it Facebook. com/CWHLMI Twitter Signature Twitter. com/cwhlorg and send us a photo and/or comment We appreciate your HAIR DONATION but there is still a HUGE COST to have a hair replacement made. com/CWHLMI Twitter Signature Twitter. com/cwhlorg and send us a photo and/or comment We appreciate your HAIR DONATION but there is still a HUGE COST to have a hair replacement made. Could you please consider contributing a tax deductible donation TODAY I HAVE ENCLOSED A DONATION TO HELP PAY FOR A CHILD S HAIR REPLACEMENT SIZE Youth Medium Fits up to child size 8 Adult SM MD COLOR Select One LG XL Youth Large Fits up to childe size 14 XXL Black Shirt w/White Writing YOU CAN SEE THE T-SHIRTS ON OUR WEBSITE XXXXL Pink Shirt w/Black Writing If you live outside the United States your order must be placed through our website www. Could you please consider contributing a tax deductible donation TODAY I HAVE ENCLOSED A DONATION TO HELP PAY FOR A CHILD S HAIR REPLACEMENT SIZE Youth Medium Fits up to child size 8 Adult SM MD COLOR Select One LG XL Youth Large Fits up to childe size 14 XXL Black Shirt w/White Writing YOU CAN SEE THE T-SHIRTS ON OUR WEBSITE XXXXL Pink Shirt w/Black Writing If you live outside the United States your order must be placed through our website www. ChildrenWithHairLoss. us Checks may be made payable to Children With Hair Loss To have your donation charged to your credit card please fill in your information below Payment Type Visa Master Card Discover American Express Credit Card Number Exp Date Name as it appears on card 3 Digit Code on Back Signature of Cardholder. .

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