Donation Form

Yes, I want to fill a critical need in Immokalee!

$1,000 - Visionary

$500 - Benefactor

$250 - Patron

$100 - Partner

$50 Supporter

* Required Fields

Gift Amount

Amount

Type of Donation

One Time Gift
Recurring Gift

Frequency

Donor Information
* First Name
* Last Name
* Address
* City
* State
* Zip
Home Phone
Business Phone
* Email
* I heard about the campaign from:

My company will match my contribution to The Boys & Girls Club of Collier County
Matching Gift Program		Company Name

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

If you selected the Recurring Pledge option, the account information provided above
will be stored securely via SafeSave™ for automatic processing of your future payments.
Simply notify us at any time if you wish to change or discontinue your pledge.

Terms/Conditions
By clicking the "Submit Payment" button, you authorize us to charge the account above for the amount specified in the Payment Amount field.

Privacy Policy
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.