Donor Information

We invite you to leave your legacy while ensuring our future success by making a planned gift to Lifetime Recovery. To receive more information, please complete the form below. You may also email Diana Reyes, Vice President of Development & Community Engagement at [email protected].

* Required Fields

Contact Information
* First Name	*Required
* Last Name	*Required
Company Name
* Address	*Required
Address 2
* City	*Required
* State/Province	*Required
* Zip/Postal Code	*Required
Home Phone
Cell Phone
Work Phone
* Email	*Required

I would like to receive more information on the following:
Bequest
Immediate Gift
IRA, Retirement Plan
Life Insurance Policy
Establish a Named Fund
Charitable Remainder Trust
Charitable Gift Annuity

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.