Donation Form

For donations of $25, we have a set of four postcards based on classic Roxie printed calendars from the 1980s, plus one raffle ticket. Donations of $50 get you the first-ever pair of Roxie socks (designed by San Francisco's own Tribe Socks), plus five raffle tickets. For a donation of $100, you receive the postcard set, the socks, and ten raffle tickets.

Raffle Prizes: Our first prize winner will receive a free rental of the Big Roxie for up to ten people to watch a movie of their choice on the big screen. Two second prize winners will receive their choice of a Spoke Art poster produced for the Roxie. Three third prize winners will receive Roxie virtual memberships!

Donation

Amount

25.00

50.00

100.00

I would like to dedicate this donation

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell 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 Roxie Theater and I will donate $0.00.No. I will donate $0.00 and Roxie Theater 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

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 by emailing [email protected].