Credit Card Donations

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Complete this form to make a donation. You can give a one-time donation or give monthly via a recurring donation. Changing Communities. Changing Lives.

Contribution Amount

$ 5.00

$ 10.00

$ 15.00

$ 20.00

$ 25.00

$ 50.00

$ 100.00

$ 500.00

Other Amount

Other Amount $

Total Amount

I want to contribute this amount every

Your recurring contribution will be processed automatically.

Donor Information

First Name *

Last Name *

Email *

Address *

City *

State *

Zip Code *

If you are giving as part of an business or organization, please enter the name below.

Organization Name

Credit Card Information

Card Type

Card Number

Security Code

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Credit Card Donations

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