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Southern Harbor Eldercare Services Donation Form
Amount
*
$5,000
$1,000
$500
$100
$50
$25
$
Donation Schedule
One Time
Monthly
Quarterly
Yearly
Email
Verify Email
Contact Information
Name
First Name
Last Name
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Phone Number
Is this gift anonymous?
Yes
Is This Gift in Memory or in Honor of Someone?
*
A meaningful way to honor a family member, friend, or colleague. These gifts preserve the memory of a loved one and help to support the mission and vision of SHES.
No
Yes
If so, please type their first and last name
First Name
Last Name
Custom text
Add 3% to my total amount to help cover the payment processing fees