Donation Form

Join REBUILD

a community of donors who change someone's life every single day

Recurring Gift

Amount

$20- gives a guest a shower and laundry service

$50- provides transportation to and from a new job

$100- provides meals to day room guests

$200- provides case management to rebuild lives

Frequency

I would like to dedicate this donation

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Cell Phone

Help Us Cover Costs

Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.

Yes! I want $0.00 to go to Carpenter's Place and I will donate $0.00.No. I will donate $0.00 and Carpenter's Place will cover the processing costs.

Payment Information

Payment Options

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

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Privacy Policy
We take precautions to protect your information. We collect credit card or bank account information, names, addresses, and other data related to your transaction when you make a payment through our site. We use this information to process your payment.

Terms/Conditions
By submitting your payment, you authorize us to charge the account above for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your monthly donation.

Carpenter's Place, 1149 Railroad Ave, Rockford, IL 61104 | [email protected] | 815-964-4105