Donation Form

Help make our CASA volunteers a permanent piece in the lives of the children they serve by registering for a recurring gift. By supporting CASA long-term, you allow our organization to plan and use resources more effectively.

Make the choice today to become a Champion for Children

Recurring Gift

Amount

$100

$50

$20

Frequency

I would like to dedicate this 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% 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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