Friends of Karen - Acceptiva

Donor Information

Salutation:

First Name: *

Middle Name:

If not applicable enter 'none'.

Last Name: *

How You Prefer To Be Addressed:

For example, if your name is Elizabeth, do you like to be called Betsy or Liz or something else?

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 for your donation will be e-mailed to this address.

Company

Company / Organization Name:

This donation is on behalf of a Company or Organization.

My employer will match my gift.

tribute gift

Making a gift in honor or in memory of a special person is a wonderful way to recognize them and provide hope and comfort to others.

Tribute Type:

Full Name of Honoree:

If you wish us to send a notification letter, please provide the following recipient information.

Salutation:

Name:

Address:

Address 2:

City:

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Special Message:

Your Payment Information

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Expiration Date: *