Please print this form, fill out and mail to: ATTN: Development. St. Mary's Food Bank.For each offline donation made, please complete a line in the chart below. Include the donor's name, complete mailing address, donation amount, check number. Tempe Community Action Agency. Please make all checks payable to. "Susan G. Komen Arizona". MAIL-IN DONATION FORM. I've attached a voided check from the account I would like to use. If you wish to make a donation, complete the mail-in form below OR send a check payable to: Hospice of the Valley 1510 E. Flower St. Phoenix, AZ 85014.