Contact Information Update

Who was your PatchWorks envelope addressed to?

• PRIMARY CONTACT INFORMATION •

Full Name *

First

Last

Preferred Name (if different)

Email Address

Home Phone Number

Cell Phone Number

Email it •

Is it okay to text this number?

Yes
No

Would you like to include a spouse or partner in your household?

Yes
No

• SPOUSE/PARTNER CONTACT INFORMATION •

Full Name

First

Last

Preferred Name (if different)

Email

Cell Phone Number

Is it okay to text this number?

Yes
No

• ADDRESS INFORMATION •

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is this a new address from what we might have on file?

Yes
No

Old Address

Address Line 1

Address Line 2

City

State

Zip Code

• COMMUNICATION INFORMATION •

I prefer to receive the PATCHWORKS NEWSLETTER via: *

Mail
Email
Both

**You will receive the electronic version IF we have a valid email address on file for you.**

I prefer to receive DONATION RECEIPTS for mailed or bill pay donations via:

Mail
Email
I only need a year-end recap

**Online and recurring donations will receive an emailed receipt IF we have a valid email address for you.**

Any other information to share with us?

Contact Information Update

• PRIMARY CONTACT INFORMATION •

• SPOUSE/PARTNER CONTACT INFORMATION •

• ADDRESS INFORMATION •

• COMMUNICATION INFORMATION •

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