Please use this form to send credit card information or a check by mail.

Just print it using your browser and mail it FACT. As we do not yet have a secure server, please DO NOT send credit card information to us via email.   Thank You!

FACT, Inc.
14 Sherbrooke Avenue
Hartford, CT 06106

Please complete: I'd like to:

             Make a one-time donation to the:

             General Donation $ _________            "Mira Fund" $ ________

             Enroll in the Foster Ferret Program and want to sponsor ____ ferret/s at $5.00 per month each.

             Please indicate here if you prefer:

                       To choose your own ferret from a current list we will send you

                        Have FACT select a ferret for you.

            Join FACT as an associate member. 1st Year is $ 25.00. Renewals are $20/yr.                             

Contact Information:

Your Name:                        ______________________________________

Street Address:                 ______________________________________

City, State & Zip Code:    ______________________     ____     ________

Phone Number:                 (_____)________________________________

Credit Card Information:

          Type:                Mastercard                   Visa                       American Express
 

           Credit Card Number:        ________________________________________

           Expiration Date:                 Month _________   Year ____________________

Authorization:

          I hereby authorize FACT to charge my credit card with the amount/s as noted above.

          Signature:  ________________________________________      Date: _________________