Donation Form

DIGNITY CIRCLE PLEDGE/PAYMENT FORM

Please use the form below to complete your payment and pledge to Designs for Dignity as a Dignity Circle Member. ANNUAL minimum contribution is $1000.00 and can be made as a one time gift of which 100% is tax deductible.

* Required Fields

Donation Information

Amount

$1,000

$1,250

Other

Type of Donation

One Time Donation
Recurring Donation

Frequency

Contact Information
* First Name
* Last Name
Company Name
* Address
Address 2
* City
* State/Province
* Zip/Postal Code
Home Phone
Cell 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 Designs For Dignity and I will donate $0.00. No. I will donate $0.00 and Designs For Dignity 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

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.

DESIGNS FOR DIGNITY: 445 N. WELLS STREET SUITE 402 CHICAGO, IL 60654