Donation Form

We know you have many options as
to where you send your donation dollars -
We thank you for choosing Belmont Housing Resources for WNY!

* Required Fields

Donation Information
Amount
Type of Donation	One Time Donation Recurring Donation
Frequency
	Complete the following fields if this gift is a tribute. (optional)
Type of Tribute
Tribute Name
Title
First Name
Last Name
Address
Address 2
City
State/Province
Zip/Postal Code
Email

Contact Information
* First Name
* Last Name
Company Name
* Address
* City
* State/Province
* Zip/Postal Code
* Home Phone
Work Phone
* Email

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 Belmont Housing Resources For WNY,Inc. and I will donate $0.00. No. I will donate $0.00 and Belmont Housing Resources For WNY,Inc. will cover the processing costs.

Payment Information
Payment Options

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

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: Belmont Housing Resources for WNY, Inc.•• 2393 Main Street, Buffalo, NY 14214 •• 716-884-7791•• [email protected]

Belmont Housing Resources for WNY, Inc. is registered and files annual financial reports with the NYS Attorney General's Charities Bureau. A copy of its latest annual report may be obtained, upon request, from Belmont Housing Resources for WNY, 2393 Main Street, Buffalo NY 14214 or from the NYS Attorney General's Charities Bureau at 120 Broadway, 3rd Floor, New York, NY 10271.