Friends of Karen - Acceptiva

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Tribute Section

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:

State:

Zip Code:

Special Message:

Guest Information

Add your guest name(s) and contact information here

Guest 1:

Email:

Cell Number:

SILVER SCREEN

If you purchased a Silver Screen Recognition, please enter a name listing or congratulatory message exactly as you wish to be recognized. Send logos to rplant@friendsofkaren.org

Congratulatory Message:

Company

This donation is on behalf of a Company or Organization.

Company /Organization Name:

My employer will match my gift.

Payer Information

First Name: *

Middle Name or Initial:

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 will be e-mailed to this address.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *