Round Up Downloadable Donation Form

To donate to the Round Up To End Homelessness program, print this page out, complete the form (be sure to provide your complete 17-digit account number) and mail (to CWLP Customer Service Office, Municipal Center West, Springfield, IL 62757) or fax (to 789-2026).

Round me up, please!

o Please round up my bill to the nearest dollar each month to
help end homeless.

o I want to make a larger contribution. Please add $_____.____
to my bill each month to help end homelessness.

Date _________________________________________________

Account # ____________________________________________

Name ________________________________________________

Address ______________________________________________

City/State/ZIP _________________________________________

Signature _____________________________________________

Return with your next CWLP bill payment or mail separately to:
                                         ROUND UP
                          CWLP Customer Service Office
                                Municipal Center West
                                  Springfield, IL 62757
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