Donation Information
Amount
$500
$250
$100
$75
$10
Type of Donation
One Time Donation
Recurring Donation
Frequency
Monthly
Complete the following fields if this gift is a tribute.
(optional)
Type of Tribute
In Memory Of
In Honor Of
Christmas Gift
Tribute Name
OPTIONAL: You may choose to make a gift in memory or honor of a person or a pet. A notification will be sent to that person or that person’s/pet’s surviving loved one if you provide a name and address for them. Your name and address will be disclosed, but not the amount of your donation.
Title
First Name
Last Name
Address
Address 2
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Contact Information
First Name
Last Name
Company Name
Address
Address 2
City
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Alabama
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Armed Forces Americas
Armed Forces Other
Armed Forces Pacific
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Connecticut
Delaware
Florida
Georgia
Hawaii
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Washington
Washington DC
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Yukon
Zip/Postal Code
Home Phone
Cell Phone
Work Phone
Email
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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 Rifle Animal Shelter and I will donate $0.00.
No. I will donate $0.00 and Rifle Animal Shelter will cover the processing costs.
Payment Information
Payment Options
Credit Card
Bank Account
Credit Card Information
Card Holder Name
Visa
MasterCard
Discover
Card Account Number
Expiration Date
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
24
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31
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33
34
Security Code
Billing Address
Same As Above
Address
City
State/Province
Alabama
Alaska
Alberta
Arizona
Arkansas
Armed Forces Americas
Armed Forces Other
Armed Forces Pacific
British Columbia
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland & Labrador
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
Yukon
Zip/Postal Code
Email
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Contact Us
: Rifle Animal Shelter •• PO Box 1375 Rifle, Co 81650•• 970-625-8808 ••
[email protected]
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