425 E. Ross Street, Waxahachie, Texas 75165
(mailing address: P.O. Box 2838, Waxahachie, Texas 75168)
(972) 937-1870 Fax (972) 937-1891 Website: www.elliscountycac.org
“In Honor/Memory” Donation Order Form
“In Honor/Memory of” Name: ___________________________________________________
(Please circle your preference)
Mail Laminated Certificate to:___________________________________________________
Address: _____________________________________________________________________
City: _________________________________State: ________________ Zip Code: _________
Amount of Donation: $_____________
Donor Name: _________________________________________________________________
Address: _____________________________________________________________________
City: __________________________________ State:_______________ Zip Code: _________
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