Donation Form

* Required Fields

Donation Information

Amount

$500

$250

$50

Other

Type of Donation

One Time Donation
Recurring Donation

Frequency

Please tell us where you'd like your gift used.

Gift Designation

If it's in someone's honor or memory, you can enter his or her name and acknowledgement address below (optional).

Type of Tribute:

Tribute Name

Title

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Contact Information
* First Name
* Last Name
Company Name
* Address
Address 2
* City
* State/Province
* Zip/Postal Code
Home Phone
Cell Phone
Work Phone
Email

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

Barnabas Center, Inc.
1303 Jasmine Street, Suite 101
Fernandina Beach, FL 32034
Phone: (904) 261-7000

Barnabas Center, Inc. is a non-profit 501(c)(3) organization. Your gift is eligible for a tax deduction to the extent allowed by law.

Donor Privacy Statement: Barnabas Center, Inc. will not sell, trade or share a donor’s personal information with other persons or organizations, nor send donor mailings on behalf of other organizations. 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.

Barnabas is registered with the State of Florida and is in good standing with regard to its Solicitation of Contributions registration (#SC-12662).

“A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE 1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. CH4494”