Donation Form

Your gift can help a child transition from uncertainty and chaos to a safe, stable, caring home.

Donation

Amount

$2,000 Support A CASA for a child for one year

$500

$100

I would like to dedicate this donation (honor or memory)

What message would you like us to share with the recipient? Up to 120 characters

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Work 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 CASA Lake County and I will donate $0.00.No. I will donate $0.00 and CASA Lake County will cover the processing costs.

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

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