Donation Form

Donation Information

Amount

Would you like to make this a monthly gift?

Type of Donation

One Time DonationRecurring Donation

Complete the following field if you would like to contribute to a specific event, program, etc. (optional)

Complete the following field if gift is a tribute. (optional)

Gift Designation

Type of Tribute

Tribute Name

Fill out the following if you would like us to notify someone of your gift. (optional)

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Contact Information

Title (Mr./Mrs. etc)

First Name

Last Name

Address

Apt., Ste., Flr. #

City

State/Province

Zip/Postal Code

Home Phone

Work 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 Carter Burden Network and I will donate $0.00.No. I will donate $0.00 and Carter Burden Network will cover the processing costs.

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

A copy of our most recently filed financial report is available from the Charities Registry on the New York State Attorney General’s website (www.charitiesnys.com) or, upon request, by contacting us at (212) 879-7400. You also may obtain information on charitable organizations from the New York State Office of the Attorney General at www.charitiesnys.com or (212) 416-8816.

Privacy Policy

The Carter Burden Network is committed to respecting the privacy of donors. When you make a payment through our site, you provide your name, contact, and payment information, andany additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited toyour account. Credit card information for online transactions will be encrypted. We will not sell, trade, or share your personal information,collected on the website or through any other business activities with anyone else.

All information concerning donors and prospective donors, including their names, addresses and telephone numbers, the names of their beneficiaries and the amount of their gift, etc., shall be kept strictly confidential by the Carter Burden Network, its staff and volunteers, unless permission is obtained from donors to release such information.

Youhave the right to review information that we have collected about you. If youhave questions or comments about our donor privacy policy or wish to reviewthat information please contact us in writing at Director of Development, 415 East 73rd Street, New York, NY 10021 or at [email protected].