Donation Form

Thanks for supporting the HOPE Family Justice Center! We cannot wait to host more Virtual Happy Hours!

In the meantime, your donation helps us continue to provide critical services for victims and survivors of
domestic violence.

Funding is needed so we can continue to provide our free wrap-around services such as counseling, shelter,
court advocacy and community support. Right now more than ever, it is also crucial for us to be able to give our
families the basic needs such as housing, food, formula, diapers so that survivors of domestic violence can get
through this difficult time.

Thank you for being a HOPE Giver!

Raffle Ticket Purchase

Amount

$100.00

$50.00

$20.00

Type of Donation

Raffle Ticket PurchaseOne Time Donation

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 percent of your intended donation is available for our mission.

Yes! I want $0.00 to go to BHcare Foundation and I will donate $0.00.No. I will donate $0.00 and BHcare Foundation 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

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 anytime if you wish to discontinue your pledge.

Central Administration Offices | 127 Washington Ave. 3rd Floor West | North Haven, CT 06473
Phone: (203) 446-9739 | Fax: (203) 446-9775
BHcare Foundation is a 501(c)(3) nonprofit organization.
The Federal Tax ID for BHcare is 22-2598799.
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