Donation Form

Donation Information

Amount

Would you like to make this a monthly gift?

Type of Donation

One Time DonationRecurring Donation

Complete the following field if you would like to contribute to a specific event, program, etc. (optional)

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

Gift Designation

Type of Tribute

Tribute Name

Fill out the following if you would like us to notify someone of your gift. (optional)

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Contact Information

Title (Mr./Mrs. etc)

First Name

Last Name

Address

Apt., Ste., Flr. #

City

State/Province

Zip/Postal Code

Home Phone

Work Phone

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 Carter Burden Network and I will donate $0.00.No. I will donate $0.00 and Carter Burden Network 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

A copy of our most recently filed financial report is available from the Charities Registry on the New York State Attorney General’s website (www.charitiesnys.com) or, upon request, by contacting us at (212) 879-7400. You also may obtain information on charitable organizations from the New York State Office of the Attorney General at www.charitiesnys.com or (212) 416-8816.

Privacy Policy
We take precautions to protect your information. We collect credit card or bank account information, names, addresses, and other data related to your transaction when you make a payment through our site. We use this information to process your payment.

Terms/Conditions
By submitting your payment, you authorize us to charge the account above for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your pledge.