Portland Insight Meditation Center

DONATION DESIGNATION *

Please select a category from the dropdown menu. If you’d like your gift divided equally among multiple categories, please list your preferences in the comments field below.

Other reason/comments:

Donor Information

Would you like your gift to be anonymous? *

First Name: *

Last Name: *

E-mail: *

A receipt will be e-mailed to this address.

I’d like to receive the PIMC newsletter and updates

Billing Address: *

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

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

PIMC is a 501-(c)(3) organization and your donation may be fully tax deductible. FEIN 93-1317966

If you wish to make changes, please contact Acceptiva at 1-800-507-3871 or clients@acceptiva.com. You may also contact PIMC at office@portlandinsight.org.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *