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Here is my donation to Feminist Women's Health Center in Washington State! $25 ×50 ×100 ×250 ×500 ×1000 Other Names) Address City, State, Zip Phone Email Credit Card # (visa or MasterCard only)

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6. If you wish to receive a tax receipt or acknowledgement for your donation, indicate this on the form and provide any additional information required to generate the receipt.
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Information that must be reported on here is my donation typically includes the donation amount, date of donation, purpose of donation, and any relevant personal information of the donor.