Child And Adult Safety Education Services, Inc (CAASES)A Non Profit Organization Donation or Product Application Please fill out and mail this form to the address indicated at the bottom of the page.  

Mail in Donation and or Product Order form

Thank you EIN:20-3748692

Fill out your Personal or Business Information:  ___New Doner   ___Return Donner   Return Donner(Date of last donation): ____/____/____ Name:_______________________________________________________________ Address:____________________________________________________________ City/Prov:______________________________ State: _____ ZIP: ________  Country _________ Daytime phone: (____) _______________   Today's Date: ___/___/___ Foreign Product orders will be subject to additional postage. charges. See 'Amount Due' section below "Not at this time".

 

Donation ____Yes, ___No (check one):  Donation check one:  ___ $20 donation)  ____$30 donation   ____$40 donation   ____$50 donation Or fill in Donation amount: I would like to Donate $__________.00 I want my donation ear marked for this safety awareness class check one: _____Stranger, _____Bully, _____Gun, _____Rape/Date Rape, _____ID Theft, _____Home Invasion, _____Weapons, _____Fitness/Health

Product ___Yes, ___No (check one):    (Stranger Safety)DVD for ages 4-9___ or ages 10-14____. $15.00 x ____ = ______total DVDs ($15.00 ea. 1-5 DVDs) $12.00 x ____= ______total DVDs ($12.00 ea. 6-299 DVDs) (Bully)DVD for ages 4-9____ or ages 10-14____. $15.00 x ____ = ______total DVDs ($15.00 ea. 1-5 DVDs)$12.00 x ____= ______total DVDs ($12.00 ea. 6-299 DVDs) (Weapons Escape)DVD ages 14-adult. $15.00 x ____ = ______total DVDs ($15.00 ea. 1-5 DVDs)$12.00 x ____= ______total DVDs ($12.00 ea. 6-299 DVDs) (Home Invasion)DVD Ages 14-adult. $15.00 x ____ = ______total DVDs ($15.00 ea. 1-5 DVDs)$12.00 x ____= ______total DVDs ($12.00 ea. 6-299 DVDs) (Rape/Date Rape)DVD ages 12-Adult. $15.00 x ____ = ______total DVDs ($15.00 ea. 1-5 DVDs)$12.00 x ____= ______total DVDs ($12.00 ea. 6-299 DVDs) Combo Fingerprint & DNA Kit ages 5-Adult. $5.00 x ____ = ______total Kits ($5.00 ea. 1-5 Kits)$4.00 x ____= ______total Kits ($4.00 ea. 6-299 Kits) Safety Helmet Identification & Emergency Lifesaving Data Kit(S.H.I.E.L.D.)ages 4-Adult. $5.00 x ____ = ______total Kits ($5.00 ea. 1-5 Kits) or $4.00 x ____= ______total Kits ($4.00 ea. 6-299 Kits) We Have A Little Emergency Kit(W.H.A.L.E.)ages New born-7 years old. $5.00 x ____ = ______total Kits ($5.00 ea. 1-5 Kits) or $4.00 x ____= ______total Kits ($4.00 ea. 6-299 Kits) Amounts:  Donation subtotal                     $__________.00 Product subtotal                     $___________.00 Foreign Postage Canada $10, Other $20 $________.00 Total Donation an/or Product Amount          $_______________________.00 Donations given to Child and Adult Safety Education Services, Inc (C.A.A.S.E.S.) Could be tax deductible as charitable contribution for income tax purposes ask your tax accountant.   Payment Information:  Payable to:(Child and Adult Safety Education Services, Inc) ___Personal check  ___Money Order  ___Cashiers check  ___ Business Check Charge to credit card     ___Mastercard  ___Visa  ___Discover    ___American Express Account #:  __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __  Exp. __ __/__ __    Signature:X____________________________________________    Mail application and payment to:  Child and Adult Safety Education Services, Inc    5029 E Cambridge AVE PHX,AZ 85008