Date: ______________________________________

Cage: Dog Cage ($750): __ Cat Cage ($250):_______ Outdoor Runs ($1,000):______

Name: _____________________________________________________________

Address: ____________________________________________________________

City/State/Zip: _______________________________________________________

Please use these lines to PRINT the exact wording you would like on your plaque:

Limit: 3 Lines, 100 Characters including spaces.

The cage donation may be in honor or in memory of a family member, friend and/or pet in the form of a memorial, or a dedication.

All contributions are tax deductible.

Mail to/Make Checks Payable to:

Bainbridge-Decatur County Humane Society

Cage Fund

P. O. Box 429

Bainbridge, GA 39818