Connecticut Legal Services, Inc.

Thank you for supporting Connecticut Legal Services with your gift to the Campaign for Justice. Your generosity will enable us to provide free civil legal services to low-income individuals who need our help to resolve urgent life problems. Every dollar you donate will make a significant difference in the lives of those we help.

Connecticut Legal Services will highlight donors in our publications in the following categories:

Champions:	$50,000 and up
Partners:	$25,000-$49,999
Trailblazers:	$10,000-$24,999
Leaders:	$5,000-$9,999
Pacesetters:	$1,000-$4,999
Sustainers:	$500-$999
Patrons:	$200-$499
Supporters:	$up to $199

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Contribution Amount

Choose A Frequency

Contribution Frequency:

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.

Optional Contribution Details

Published Name:

Please type your name(s) as you would like it appear in our list of donors published in our Spring Newsletter, our Annual Report, and the Connecticut
Law Tribune.

Do not publish:

Check here if you prefer NOT to have your name included in our published donor list.

Contribution made:

Please indicate if your contribution is being made in honor or in memory.

Honoree Name:

Please enter the name in honor/memory of.

Name & Address:

Please enter the name and mailing address of person(s) we should notify of your donation.

Law Firm/Company Name:

Law Firm/Company Contribution:

Check here if this is a gift on behalf of your law firm/company.

Comments or Questions:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *