Online Payment Form - Liberation Veteran Services

Name*

First Last

Email*

Phone*

Mailing Address*

Street Address City State ZIP Code

Dedicate my donation in honor or in memory of someone

Yes

In honor / memoriam*

In honor of
In memory of

In memory of*

Honoree Name*

Honoree Email*

Honoree Phone*

Honoree Address*

Street Address City State ZIP Code

Person to Notify*

Recipient name

Notify this person by*

Email
Postal mail

Recipient's Email*

Recipient's Address*

Street Address City State ZIP Code

Message for the recipient

Message is optional.

Donation*

Please choose a donation amount.

Donation Amount*

Make this an Annual Gift?

If you'd like to make this donation automatically every year, please check the box below.

Yes

Please Choose your Designation

General Operations (Annual Fund)
Capital Project (Veterans Village)

How should your name/s appear in our thanks?

e.g. :"John Smith", "John and Jane Smith", "Mr. and Mrs. John Smith," "The Smith Family", "The Smith Company"

Please contact my company for a donation match

Yes

Company Name*

Contact's Email*

Contact's Phone

Company Address*

Street Address City State ZIP Code

Credit Card*

American Express

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Card Number Expiration Date Security Code Cardholder Name

Notes

Please include a note if you would like to pass any additional information to us.

Donation Amount

$0.00