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GIVE 2

"*" indicates required fields

Please select the type of donation and the amount you would like to donate.*

I would like to make a monthly recurring gift.

I would like to make a gift for the following amount:

Here's my gift amount:*

if other:*

Recurring Amount:*

if other:*

I would like to apply my donation to:*

Credit Card Information

Please enter the credit card information below.

Credit Card*

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Name as it appears on card:

Donor's Billing / Mailing Address

Please enter your billing / mailing name and address below. Your billing information must EXACTLY match the address printed on your billing statements.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address*

Company: (if applicable)

Mailing Information Matches Billing Information?*

Yes

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I would like to receive a presentation certificate for my gift of $200 or more*

Yes

I would like to donate my gift to a disaster victim.*

Yes

Presentation Certificate Information

The Wheelchair Foundation Wishes To Thank:*

For The Gift Made In The:*

First & Last Name*

Presentation Folder Mailing Address Same As Billing Address?

Yes

Presentation Folder Mailing Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about Wheelchair Foundation?

Please select from below

School Name

Other

If "Other" was selected, please describe.

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GIVE 2

Credit Card Information

Donor's Billing / Mailing Address

Presentation Certificate Information

How did you hear about Wheelchair Foundation?

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