Donor Information First Name Last Name Home Address City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Email Address Phone Number Credit Card Donation Would you be willing to cover the 3% online processing fee? Yes No Frequency of Your Donation One-Time Donation Recurring Donation (monthly) Recurring Donation (every 3 months) Recurring gifts will occur perpetually until you notify our office to stop payments. You may provide special instructions in the "Donor Notes" field below. One-Time Amount $10 $25 $50 $100 $250 $500 Other… Amount $ Monthly Recurring Amount $5/month ($5.15/month charged) $10/month ($10.30/month charged) $25/month ($25.75/month charged) $50/month ($51.50/month charged) $100/month ($103/month charged) $250/month ($257.50/month charged) Quarterly Recurring Amount $50/quarter ($51.50/quarter charged) $125/quarter ($128.75/quarter charged) $250/quarter ($257.50/quarter charged) $500/quarter ($515/quarter charged) $1000/quarter ($1030/quarter charged) $1,250/quarter ($1287.50/quarter charged) Frequency of Your Donation One-Time Donation Recurring Donation (monthly) Recurring Donation (every 3 months) Recurring gifts will occur perpetually until you notify our office to stop payments. You may provide special instructions in the "Donor Notes" field below. One-Time Amount $10 $25 $50 $100 $250 $500 Other… Amount $ Monthly Recurring Amount $5/month $10/month $25/month $50/month $100/month $250/month Quarterly Recurring Amount $50/quarter $125/quarter $250/quarter $500/quarter $1000/quarter $1,250/quarter Donor Notes Payment Information Update Submit Mail a Check Make Checks Payable to: ABC Company Mail Checks to:ABC Company123 Charity LaneDonorville, CA 99999 Venmo
