Donation Form

* Required Fields

Donation Information
Your name as you wish to be acknowledged
Amount
Type of Donation	One Time Donation Recurring Donation
Frequency

In Honor of (#1):
	Please notify the following person(s) that a donation has been made in honor of their loved one:
First and Last Name
Address

In Honor of (#2):
	Please notify the following person(s) that a donation has been made in honor of their loved one:
First and Last Name
Address

In Honor of (#3):
First and Last Name
	Please notify the following person(s) that a donation has been made in honor of their loved one:
Address

In Honor of (#4):
First and Last Name
	Please notify the following person(s) that a donation has been made in honor of their loved one:
Address

In Honor of (#5):
First and Last Name
	Please notify the following person(s) that a donation has been made in honor of their loved one:
Address

Contact Information
* First Name
* Last Name
* Address
* City
* State/Province
* Zip/Postal Code
Home Phone
Work Phone
* Email

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

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.