Everyone making a donation to Charity Coins will receive a tax-deductible receipt for your records.   This receipt will include the following information contained on this page.  Please print and fill out each blank for as many coins as you wish to donate!  In addition, there is a space for financial contributions for those who believe in our mission and purpose.   Please consider investing in those with little future and hope.  It costs so little to accomplish so much!

Help us change nations!  

Donation Form:               (The PAYPAL / Donation link is listed below this form.)

Name:______________________________________________________

Company:____________________________________________________

Street & Number:______________________________________________

City, State & Zip:_______________________________________________

Phone: (______)__________________  Work: (_____)_________________

email:_______________________________________________________

Note:  we will never sell or disclose any of the above personal information, ever.  This is only for our use in case we need to contact you regarding your donations.

Coin Denomination: _____________________________________________

Date & Mint: ______________________   Variety:_____________________

Condition or Grading, // Holder and Grade: ____________________________

Value and Source: ______________________________________________

                                 ______________________________________________

Donors Comments:______________________________________________

                                  ______________________________________________

                                 ______________________________________________

Cash Contribution:  $________________     Please Circle:        Visa        MC

Card #:  _________________________________   Exp. Date:_____/_____

Name as it appears on your card: ____________________________________

Signature: ____________________________________________________

Please make check payable to:  Charity Coins. 

Please mail coin and or contribution to: 

Charity Coins, P.O. Box 300, Lemont, PA 16851

Donate securely with any major credit card through PayPal!

 Shipping Notes:

• Please consider sending your coin(s) by registered or insured mail.  Save the receipt as this cost is also tax-deductible.
• We cannot give receipts for donations that we never receive.  Please consider sending your donations via delivery confirmation.  For the current cost of $0.40, this is inexpensive peace of mind.       
• Send your coin(s) to:  Charity Coins, P.O. Box 300, Lemont, PA 16851.