Leaven Community · Be+Love+Act New

Donation Information

Amount

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$1,000

$500

$250

$100

$50

$25

$

Donation Schedule

Is This A Pledge Payment?

Donor Designation for Funds

General Fund

Emergency Fund

Memo

Is this a gift in honor or memory of someone?

No

Yes - in honor of

Yes - in memory of

Please provide the name and contact information of the honoree

Please provide the name of the deceased

(Optional) Please provide contact information for a relative or friend of the deceased

Name

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First Name

Last Name

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

Email

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