Donation Form I would like to make a tax deductible contribution of (required) Platinum Partner $10,000Gold Partner $5,000Silver Partner $2,500Major Gift $250Special Donor $100Friend $50Other Amount Donor's Information Full Name (required) Email (required) Phone Number (required) Street Address City State Zip Code Any Special Designation (such as in someone's memory--please include their name) Purpose of Gift: Is your gift for general operations? Or toward one of the following programs? If so, please indicate which of the following —Please choose an option—Emergency Assistance: (hygiene items, clothing, gift cards for food, etc.)Holiday Cheer (food, toys, gift cards, cash, clothing)I would like to volunteer at the Center (a staff member will contract you at the number above) Billing Information Full Name (required) Email (required) Phone Number (required) Company Name Street Address 1 Street Address 2 City State Zip Code Country I may be contacted by email Tribute Gift Information Yes, this is an honor or memorial gift. Recipient's first name Payment Information Credit Card Type —Please choose an option—VisaMasterCardAmerican ExpressDiscover Credit Card Number CVV Number Expiration Date Month (MM) Expiration Date Year (YY) Δ