Donation Form

Make a donation in honor or memory of a loved one and put your love to WERC! These donations honor all of the

behind-the-scenes supporters who are not publicly proclaimed, yet have a shared legacy to

"Live Life with Passion and Make a Difference!"

WERC Donation Information

Amount

Please enter the amount you wish to donate to WERC's Heroes Fund below.

Type of Donation

One Time DonationRecurring Donation

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

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

Privacy Policy
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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.