General Donations

Thank you for your donation to the DSA-GC!

Your support is greatly appreciated!

Please provide your contact and payment information.

* Denotes required information.

Personal Donation
Organization / Business Donation

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* First Name:
* Last Name:

Contact Information


	Home Work

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* Address:
* City/Town:
* Country:
* * * * Province/State:
* Postal/Zip Code:
Phone Number:	( ) Ext.
Cell Phone Number:	( )
* Email Address:

Allow Down Syndrome Association of Greater Charlotte Inc to contact me by email.
I give Down Syndrome Association of Greater Charlotte Inc permission to contact me by mail (post).

Designation

If you would like your donation to be applied to a specific program or event, please indicate that here. Thank you.

Matching Gift

Your employer may match your gift. Enter your employer name below to see if your company offers matching gift.

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Payment Information

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Payment Method:	One Time Payment Credit Card Monthly Payments Credit Card
* * Donation Amount:	$10.00 $15.00 $25.00 $50.00 $100.00 $50.00 $100.00 $150.00 $250.00 $500.00 $750.00 $1,000.00 Other
Did you know that by covering the processing fee, Down Syndrome Association of Greater Charlotte Inc will be able to help more people?
I want to cover the fees for my donation ( %ProcessingFee% ).

* Processing Date:
* Number of Installments:
	installments
Pay using PayPal
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* Credit Card Number:
* Card Security Number:	Where is my Card Security Number?
* Cardholder's Name:
* Credit Card Expiration:



* Bank Name:
* Bank ID:
* Cheque Number:
* Transit number:
* Account Number:

Security Check

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