Friends of Karen - Acceptiva

this gift is for

This Gift is for: *

Other:

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.
For a gift of $250 or more, consider a brick tribute gift, see below.

Tribute Type:

Full Name of Honoree:

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

Salutation:

Name:

Address:

Address 2:

City:

State:

Zip Code:

Special Message:

(up to 250 characters)

BRICK TRIBUTE GIFT

For a gift of $250 or more, please consider giving a brick in honor or in memory of a loved one. Dedicating a personally inscribed brick in the pathway of loving messages at our North Salem headquarters is a lasting and meaningful tribute.

Please include your brick message here… (20 characters per line includes space, commas, period) You will receive a replica brick with the same message. For more information contact AmyHosmer@friendsofkaren.org

The full cost of your gift, minus $12.95 for the replica brick is tax-deductible.

Brick Message:

Please provide recipient information to receive replica brick and notification letter.

Full Name of Honoree:

Salutation:

Name:

Brick Address:

Address 2:

City:

State:

Zip Code:

Special Message:

(up to 250 characters)

Company

Company / Organization Name:

This donation is on behalf of a Company or Organization.

My employer will match my gift.

Donor Information

Salutation:

First Name: *

Middle Name:

If not applicable enter 'none'.

Last Name: *

What you like to be called:

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.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *