Donation Form

Donation

Amount

Type of Donation

One-time Donation
Recurring Donation

Frequency

NEW! Donate stock. Learn more.

Complete the following fields if this gift is a tribute. (optional)

Type of Tribute

Please send an acknowledgement to the following person(s) to inform them that a gift has been made in their honor or in memory of their loved one.
Include their full name and mailing address.

Tribute Name

Title

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Donor Contact Information
* Title (Mr/Ms)
* First Name
* Last Name
Spouse Name
* Email
Country
* Street Address
Street Address 2
* 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 $0.00 to go to Beyond Batten Disease Fdnt. and I will donate $0.00. No. I will donate $0.00 and Beyond Batten Disease Fdnt. will cover the processing costs.

Credit Card Information
Card Holder Name

Card Account Number
Expiration Date
* Security Code The 3 or 4 digit Security Code (CVV2) can be found on the back of your credit card. For American Express, the Security Code (CID) can be found on the front of the card.

Billing Address
Same As Above
* Address
City
State/Province
* Zip/Postal Code
Email

Beyond BattenDisease Foundation is a registered 501 (c) 3 organization with Tax ID#26-3223661

Disclaimer

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.

Contact Us: Beyond Batten Disease Foundation •• 3305 Steck Ave., Suite 200, Austin, TX 78757 •• 877.6BATTEN •• [email protected]