Panola College Foundation - Acceptiva

Panola College Memorial/Honorary Gift Form

When making a memorial or honorary gift, please include your name, address, and telephone number along with the name and address of the surviving family member or honoree to whom notice of the gift should be sent.

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Gift Amount:

Donor Information:

Salutation:

First Name: *

Middle Initial:

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Please make my gift:

Name: *

Please acknowledge this gift to:

Name: *

Address:

City:

State:

Zip Code:

Please apply my gift to:

A specific scholarship:

Your Payment Information:

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *