Donation Form

Honorarium and memorial gifts are a great way to pay tribute to the loved ones in our lives. With your gift, Greater Lynchburg Habitat for Humanity can empower local families through our homeownership program.

It’s simple. When you make your gift, provide the name and address of the one you would like to be notified, and we will send them a beautiful card that tells them of your generosity. As always, we promise your gift will help build a Lynchburg where everyone has a decent place to live.

Donation Information

Amount

$250

$100

$50

Type of Donation

One Time DonationMonthly Donation

I would like to dedicate this donation

Complete the following fields.

Tribute Name

Send Notification to:

Title

First Name

Last Name

Address

Address 2

City

Zip/Postal Code

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Work Phone

Payment Information

Payment Options

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

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 pledge.