Donation Form

Your generous support can help provide puppy mill survivors with the care many of them so desperately need as we prepare them for life as cherished family pets.Thank you!

Contact Information

First Name

Last Name

Company Name

Address

City

State/Province

Zip/Postal Code

Country

Home Phone

Cell Phone

Work Phone

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Birthday Month

Birthday Day

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

If you selected the Recurring Pledge option, the account information provided above
will be stored securely via SafeSave™ for automatic processing of your future payments.
Simply notify us at any time if you wish to discontinue your pledge.

Terms/Conditions
By clicking the "Submit Payment" button, you authorize us to charge the account above for the amount specified in the Transaction Amount field.

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.

Return Policy
If you have any questions or concerns with your payment, please contact us using the information provided in the Contact Us section.

Contact Us: National Mill Dog Rescue, P.O. Box 88468, Colorado Springs, CO 80908 • (719) 683-3334 • [email protected]