Donation Form

* Required Fields

Donation Information

Amount

$500

$250

$50

Other

Type of Donation

One Time Donation
Recurring Donation

Frequency

Memo

Contact Information
* First Name
* Last Name
Company Name
* Address
Address 2
* 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 Loudoun Habitat For Humanity and I will donate $0.00. No. I will donate $0.00 and Loudoun Habitat For Humanity 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

Express Consent

By entering a telephone number or email in one of the above fields, you agree to receive occasional messages from Loudoun Habitat for Humanity to the provided mobile number/email address. Text message & data rates may apply. Reply STOP via text to cancel. Reply HELP via text for info.

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.