Donate Now and be a part of the miracle
Thank you for your decision to support Serenity House.

After you fill out this form, choose Print from the File menu, and mail it to
Serenity House.

NOTE: Credit card information is required to ensure your credit card is securely and properly processed. 
This information is solely used for the processing of the credit card.

* Denotes required information.

Gift Information

Help provide for a client's first week in treatment through the
Serenity House Indigent Client Benevolence Fund.

$ 25   $50 $100   Other $  

Help meet a client's Medical/Dental/Optical needs through the
Serenity House Medical/Dental/Optical Program.

$ 25   $50 $100   Other $  

Help provide more accommodations for those in need through the
Serenity House New Building Fund.

$ 25   $50 $100   Other $  

Create a permanent tribute by purchasing a
Serenity House Circle Tile.

4" x 8" Tile—3 Lines—Max. 20 characters per line 
     
 
 
     
8" x 8" Tile—6 Lines—Max. 20 characters per line
     
   
 
 
 
 
 
 
 
     
 
Please send me more information about:
Endowment Fund
Room Dedication
Other
 

.
Contact Information
 
E-mail Address:
I may be contacted by e-mail.
 
Title:
 First Name:
 MI:
Last Name:
 Suffix:
Company/Organization Name:
Address Line 1:
(e.g. 1234 Main St Apt 102)
Address Line 2:
City:
 State :
 Zip/Postal Code:
     
Country:
 

Daytime Phone:
Evening Phone:
(Example US: (###)###-####)
 
if simply requesting information, skip Credit Card Information.
Credit Card Information
 
Credit card information is the same as contact information.
 
* E-mail Address:
 
* First Name:
 MI:
 * Last Name:
* Address Line 1:
(e.g. 1234 Main St Apt 102)
Address Line 2:
* City:
 * State:
 * Zip/Postal Code:
     
* Credit Card Number:

*  Payment Method

 *  Expiration Date:
 
 

After you fill out this form, choose Print from the File menu, and mail it to
Serenity House.
If you do not wish to use a credit card, simply mail this form, along with a check to:
Serenity House
891 So. Route. 53
Addison, IL 60101
630.620.6616
(map)
Email: serenity@serenityhouse.com