Donation Form

Thank you for participating in a virtual fundraiser and making a difference for children, adults, and families affected by autism!

Please contact your event host for details.

Donation Information

Amount

Type of Donation

One Time DonationRecurring Donation

Which program would you like to support?

Contact Information

First Name

Last Name

Fundraiser Host

Address

Address 2

City

State/Province

Zip/Postal Code

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 Autism Treatment Center and I will donate $0.00.No. I will donate $0.00 and Autism Treatment Center 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

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.