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Mary's Place by the Sea Donation Form
Donation
*
$
400
-
Host a woman for a day
$
100
$
50
$
25
$
Donation Schedule (Single or Recurring)
One Time
Monthly
Quarterly
Annually
Weekly
Is this gift in Honor or Memory of someone?
*Please complete the questions following this one.
No
In Honor*
In Memory*
Please provide the name of person to be honored or memorialized
To whom should we notify regarding this tribute gift? Please provide the NAME and ADDRESS of the person(S) to be notified.
Donor/Contact Information
Billing information
Name
*
Prefix
First Name
Last Name
Suffix
Name (Secondary, if applicable)
Prefix
First Name
Last Name
Suffix
Organization/Employer (if applicable)
Address
*
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Email
Phone
Special Note
Add 3% to my total amount to help cover the payment processing fees