Friends of Karen - Acceptiva

4" x 8" Brick

Tax Deductible Contribution
Customized with 3 lines of text
(20 characters per line including spaces)
ANY SYMBOL IS CONSIDERED ONE SPACE
(PERIOD, COMMA, DASH).
ALL TEXT IS CENTERED

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Qty

Description

Amount

Total

4" x 8" Brick

$250.00

Replica brick with the same message

$16.95

I would like to pay the 3% credit card processing fee so that Friends of Karen receives my full contribution.

Brick Information

Line 1:

Please only 20 characters per line including spaces.

Line 2:

Please only 20 characters per line including spaces.

Line 3:

Please only 20 characters per line including spaces.

Tribute Information

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. If you would like, we will send a letter to a recipient of your choice informing them of your thoughtful gesture.

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:

State:

Zip Code:

Payer Information

First Name: *

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.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *