Name
Address
Phone #                    City                         State          Zip
Further credit WaterStone-#7528        Fund name: Go Home Foundation
Frequency  (Circle One)     One Time    Monthly or Quarterly  (transactions processed approx. on the 15th)
Amount $	Visa/MasterCard
Card Number                     3 digit code	Expiration Date:
Card Holders Signature
Under Internal Revenue Code deductibility of donations to non-profit organizations such as WaterStone, Inc. occur only when the donor makes an outright gift or there is a gift greater than the value of something received in exchange.  All contributions are complete and unrestricted gifts to WaterStone.