Yes, I want to be included in the "Friends of Linda Ekstrom"
Campaign
Designation
GLAccount
Please count on me with a special gift:
5000.00
2500.00
1000.00
500.00
100.00
Other
Other Amount
$
Name Recognition
(Name exactly as you would like it to appear on wall)
Keep my contribution anonymous
Yes
No
Payment
Gift Amount
$
Payment Type
Please select...
MasterCard/VISA
AMEX
Discover
EFT/ACH/e-Check
Name on Card
Card Number
MM
YY
CVV Code
4 digits for AMEX cards.
x
Name
Account No.
Routing No.
Routing and Account
Type
Checking
Savings
Donor Information
First
As you would like it to appear in our records.
x
Last
Street
City
State
Zip
Phone
Type
Please select...
Cell
Work
Home
Other
Phone Type
x
Email
Spouse
Spouse
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Contact Information