Ithaca Neighborhood Housing Services
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Secure Donation Form
Amount
*
$500
$250
$100
$50
$25
$
Donation Frequency - Recurring donations are the best way to give steady support
One Time
Monthly
Quarterly
Yearly
DONOR INFORMATION
Your Name
*
First Name
Last Name
Email
*
Verify Email
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Phone
Spouse/Partner First & Last Name
Company Name
If this is a business gift, please indicate the company name, otherwise leave it blank.
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
ADDITIONAL DONATION INFORMATION
Would you like this gift to be made anonymous?
If you select "Yes" below, you will not be listed in our annual Community Report.
Yes
Would you like to make this gift in honor or memory of someone?
No
Yes, In Honor
Yes, In Memory
Name of honoree
First Name
Last Name
Name and Address to notify honored person
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email of honored person
Verify Email
Name of deceased
First Name
Last Name
Do you want us to notify a family member of this memorial gift?
Yes
No
Person to be notified of this memorial gift
First Name
Last Name
Notification Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Notification Email
Verify Email
Donate 100% - Add 3% to my total to cover payment processing fees so that 100% of my donation goes to Ithaca Neighborhood Housing Services