Donation Form

A tribute is the perfect way to show your support of Pink Aid's mission and community. Honor or memorialize a special friend or loved one or member of the Pink Aid family with a tribute.

To appear in Journal as:

"Donor Name in Honor/Memory of Tribute Name"

Tribute Purchase

Amount

Name of Donor

Type of Tribute

Name of Tribute

If you purchased more than one tribute, please enter the tribute information in the format of "Donor Name in Honor/Memory of Tribute Name".

Contact Information

First Name

Last Name

Address

City

State/Province

Zip/Postal Code

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 $100.00 to go to Pink Aid and I will donate $103.00.No. I will donate $100.00 and Pink Aid 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 Pink Aid is encrypted and stored securely via SafeSave™ for automatic processing of your future payments.