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Order Form: Note: If you have more than one Memorial or Honorarium, this form may be duplicated.

Make check payable to: SWVA Second Harvest Food Bank Brighten A Life Mail to: 1025 Electric Rd. Salem, VA 24153.
Please send Thank-you card to:
Donor's Name (s):____________________________________________________Phone:______________________________

Address:________________________________________________City:____________________State:_______Zip:__________

My donation of $_________to SWVA Second Harvest Food Bank is enclosed.


___ In Memory of Name:_______________________________________
___ In Honor of Name:_______________________________________

Please send Gift Notification Card to: (one card per donation please)
Name (s):_________________________________________________________Phone:_________________________

Address:________________________________________________City:____________________State:_______Zip:__________