Donation Form

The Lighthouse Program Playground Fund

 Thank you for making a contribution to Brandywine Counseling.

Please make check payable to Brandywine Counseling and mail with this completed form to: 

 

Brandywine Counseling

2713 Lancaster Avenue

Wilmington, DE 19805

Name:_________________________________________________________________

Address:_______________________________________________________________

City: ______________________________ State: __________ZIP: _________________

Phone:___________________________   E-mail: ______________________________

Please accept my donation of:    o $500    o $100    o $50     o Other______________

o In honor of: ____________________    o In memory of: _______________________

o I would like my gift to be anonymous.