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Is this a meal contribution for a Meals on Wheels client?
*
select one
Yes
No
This form is for charitable donations to Horizons
If making a payment for Meals on Wheels service, please use our separate
meal contribution form
.
I wish for my charitable donation to go toward
*
Meals on Wheels - Linn County
Meals on Wheels - Johnson County
Financial Health & Wellness
Neighborhood Transportation Service
Wherever it's needed most
Amount
*
$100
$50
$25
$
Donation Schedule
One Time
Monthly
Quarterly
Yearly
Contact Information
I am donating
*
as an Individual
on behalf of an Organization
Name
*
First Name
Last Name
I wish to make my charitable donation anonymous.
Yes
Organization/Employer
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email
Verify Email
Tribute/Memorial
This charitable donation is made
In Honor of
In Memory of
Name
First Name
Last Name
Please notify the tribute or their representative of my gift.
Yes
Contact person for tribute/memory
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Add 3% to my total amount to help cover the payment processing fees
