Donation Form

Join our club. Give monthly.

	What is the Champions Club?

	Our Champions Club is a community of monthly givers empowering adults with disabilities on their journey toward realizing their goals and dreams. As a member of the Champions Club, your monthly gift will help us focus on providing meaningful life enrichment and employment opportunities.

	What Champions Are Saying


			"I've been a long-time supporter of Merrick Inc., and I have had the privilege of serving on the Board of Trustees for the past few years. With life as busy as it is, I often found myself forgetting to make a monthly contribution, until the option to become a "monthly giver" became available. It was easy to set up the automatic payments, and I'll never again forget to contribute to the organization I am so proud to support." - Champion Crystal Saric-Fashant

	Important Things to Note

	Help Us Cover Costs - Pledges processed through our automatic processing gateway include the gift amount and the "Help Us Cover Costs" amount for each recurring gift. Pledge Start Date - Automatic monthly giving is based off the start date of your pledge i.e. the date of your first monthly gift is the date that the system uses to calculate when a payment is due to be processed. If you want to change the day of the month on which your monthly gift is processed, please contact Megan Kuneli at (651) 789-6207 or [email protected].

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 Merrick, Inc. and I will donate $0.00.No. I will donate $0.00 and Merrick, Inc. will cover the processing costs.

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

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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.