Donation Form

Donation

Amount

$25 (1 bottle)

$50 (2 bottles)

$100 (4 bottles)

Gift Notes

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Phone

Church or Group Name (to include your total in your group's results)

Help Us Cover Costs

If you would like to help Align Life Ministries cover the processing costs of this transaction, please check "yes" below.

Yes! I want $0.00 to go to Align Life Ministries and I will donate $0.00.No. I will donate $0.00 and Align Life Ministries 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

Align Life Ministries is a non-profit 501(c)(3) organization. Contributions are tax-deductible to the fullest extent of the law.

The official registration and financial information of Align Life Ministries may be obtained from the PA Dept. of State by calling toll-free within Pennsylvania 1-800-732-0999. Registration does not imply endorsement.