Recurring Donation Form (for a one-time donation CLICK HERE)


Please complete the form below and click on "Submit”.

 

To submit this form, all "*" fields must be filled in.


      NOTE: To set an end date to this recurring donation, please contact Mary Wilcosky (info on right)


Recurring Amount*
Frequency*

Salutation
First Name*
Last Name*
Address*
City*
State*
Zip*
Phone
Email*
Confirm Email*
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Payment Info