Donation Form

701 Retreat Drive, Suite #400, Naples, Florida 34110

PROGRAM FUND - SCHOLARSHIP FUND - WHERE NEEDED MOST
DONATION FORM

Step 1: Enter Donation Information

Donation Information

Contact Information

Confirmation

Payment

Donation

FUND SELECTION - Please select one of the Funds shown below.

Contact Information

Donor First Name

Donor Last Name

Address

City

State/Province

Zip/Postal Code

Home Phone

Cell 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 Bentley Village Foundation and I will donate $0.00.No. I will donate $0.00 and Bentley Village Foundation will cover the processing costs.

Payment Information

Payment Options

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

BENTLEY VILLAGE FOUNDATION, INC. IS AN IRS-APPROVED 501(c)(3)PUBLIC CHARITY AND A FLORIDA NOT-FOR-PROFIT CORPORATION. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. Contact: 1-800-HELP-FLA (435-7352); www.FloridaConsumerHelp.com. REFER TO CH47269.

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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.