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Complete this form and your contribution will come directly from your checkbook to USA Cares. USA Cares will not collect account information or provide information to third parties. USA Cares, Incorporated, is a Kentucky-based nonprofic corporation recognized by the U.S. Internal Revenue Service as tax exempt under the provisions of IRS Section 501(c)(3). Donations received by USA Cares may offer the contributing individual or corporation the greatest tax benefits allowed by law. Please consult your tax advisor if you have any questions.
 

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First Name:

Last Name:

Address1:
Address2:
City:
State/Zip:
Phone:
Drivers License Number:
DL Issue State:
SSN:
Birth date (mmddyyyy):
E-Mail:
 *Bank Route Number:
 *Bank Account Number:
Check Number:
Amount:
In Memory/Honor of: