DONATION TO JANUS OF SANTA CRUZ
Every donation makes a difference in someone’s life by directly supporting the treatment, recovery, care and education of a Janus
client. Here are just a few of the ways that your tax-deductible gift to Janus can be put to use:
Please use my donation to support the following program(s)
Where the need is greatest.
Residential Treatment
Perinatal Residential
Special Care/Detox
Outpatient Services
The Community Clinic for Opiate Addiction
DUI Programs
Sober Living Homes
My donation is in honor of:
_____________________________
My donation is in memory of:
_____________________________
Your name:
__________________________________________
Your address:
__________________________________________
City/State/Zip
__________________________________________
Phone number
__________________________________________
Payment Information:
My check is enclosed for $ _____
OR
You may charge my credit card $______
Credit Card Information:
Card is:
Visa
Master Card
American Express
Other ________________
Credit Card Number: ____________________________________
Expiration Date: __________
3-digit security code from front or back of card: __________
Please sign here to authorize that charge:
______________________________________________________
Janus Tax ID# 94-2739130
Mailing List Information:
Would you like to be included on our mailing list?
Yes
No
Be assured that your personal information is private and secure. Janus will not share your name, address or phone number with
any other agency or individual.
On behalf of recovering people everywhere, thank you for supporting Janus of Santa Cruz.
Rod Libbey
Executive Director
Janus of Santa Cruz