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Habitat for Humanity Lakeside Donation Form
Donation Amount
*
$1,000
$500
$100
$50
$25
$
Frequency of Donation
One Time
Monthly
Yearly
Weekly
Designation of Donation
*
Select a specific program to support or leave your gift as unrestricted so we can use it where it's needed most.
select one
Where it's needed most (unrestricted)
Home Buyer Program
Home Repair Program
Rock the Block Program
Type of Donation
*
Individual
Company
Recognition Name
*
Please list how you would like your name to appear in our annual report: Anonymous, Jon & Jane Doe, Jon and Jane Doe, Business Name, Etc...
Is this donation in memory or in honor of someone?
*
Yes
No
Who is the donation in memory or in honor of?
*
First Name
Last Name
Would you like Habitat for Humanity Lakeside to send an acknowledgement to this person or one of their family members to let them know you made a donation in memory or in honor of them?
*
Yes
No
What is the name and address of the person you would like the acknowledgement sent to?
*
Comments
*
Contact Information for Billing
Name
*
First Name
Last Name
Company Name
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email
*
Verify Email
*
Home Phone
Work Phone
Cell Phone
Add 3% to my total amount to help cover the payment processing fees
