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Mailing Information Matches Billing Information?*

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Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I would like to receive a presentation certificate for my gift of $150 or more*

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Presentation Certificate Information

The Wheelchair Foundation Wishes To Thank:*

For The Gift Made In The:*

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Presentation Folder Mailing Address Same As Billing Address?

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Presentation Folder Mailing Address:*

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How did you hear about Nevada Wheelchair Foundation?

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Credit Card Information

Donor's Billing / Mailing Address

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How did you hear about Nevada Wheelchair Foundation?

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