Donation Form

Camp Herrlich

101 Deacon Smith Hill Road, Patterson, NY 12563

Phone: 845-878-6662

Email: [email protected]

www.campherrlich.org

* Required Fields

Donation Information

AMOUNT

$500

$250

$50

Other

Type of Donation

One Time Donation
Recurring Donation

Frequency

Recurring Gift
Start Date (1st payment is charged the day you submit this form; all subsequent will occur on the date you specify starting with the NEXT payment)

Designation of
Gift

Comments

This is being given in honor or in memory of
(If applicable)

Tribute name(s)

If you would like someone to be notified that you have given a gift in honor or remembrance of someone, please provide contact info here.

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Your Contact Information
* First Name
* Last Name
Company Name (if using business address)
* Address
* City
* State/Province
* Zip/Postal Code
Home Phone
Cell Phone
Work Phone
* Email

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 Camp Herrlich and I will donate $0.00. No. I will donate $0.00 and Camp Herrlich will cover the processing costs.

Credit Card Information
Card Holder Name

Card Account Number
Expiration Date
* Security Code The 3 or 4 digit Security Code (CVV2) can be found on the back of your credit card. For American Express, the Security Code (CID) can be found on the front of the card.

Billing Address
Same As Above
* Address
City
State/Province
* Zip/Postal Code
Email

Privacy Policy
We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited to your account.

Contact Us: Camp Herrlich •• 101 Deacon Smith Hill Road, Patterson, NY 12563 ••

Phone: 845-878-6662 •• Email: [email protected] •• Website: www.campherrlich.org