Donation Form

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Next Steps: Install a Payment Add-On

To accept donations via this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https://www.gravityforms.com/blog/payment-add-ons). Important: Delete this tip before you publish the form.

Name(Required)

First Last

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Enter Email Confirm Email

Donation Amount(Required)

Choose how much you would like to donate.

Other Amount

Total

Would you be willing to also donate to cover our credit card processing fees?

Yes, I can cover the fee (2.9% + $0.30)

Not at this time

Fee Donation (Calculated)

Price: $0.00

Donation Memorial

I would like to donate on another person's behalf or dedicate my donation to someone.

Dedication Name

Please enter the name of the person who you would like to dedicate the donation to.

Special Acknowledgement

I would like to send an acknowledgement to another person/people.

Special Acknowledgement Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Credit Card

Card Details

Cardholder Name

Next Steps: Install a Payment Add-On

24-HOUR HELPLINE: 724-775-0131

ADDRESS

OFFICE TELEPHONE

EMAIL