Donation Form

 

Gift Information
Amount:	$1,000.00 $500.00 $200.00 $100.00 $25.00 $20.00 $10.00 Other $     *
Select Your Frequency
Type of gift:	One-Time Monthly
Frequency:	Weekly Monthly Quarterly Annually Every 4 weeks On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending Date:   Ending:
A $20 monthly gift qualifies you for a Kesslers sterling silver bracelet, would you like this?:	No Yes
Would you like to receive the $500 Kesslers Diamonds Splurge Card?:	No Yes
What station were you listening to?	B-93.7 Star 105.7 I wasn't listening to the radio
Billing Information
Title:	Dr. Miss Mr. Mrs. Ms. Pastor Reverend
First name:		*
Last name:		*
Country:	Argentina Australia Canada Cyprus Czech Republic Denmark Germany India Indonesia Italy Japan Malaysia Micronesia Netherlands New Zealand Philippines Singapore South Korea Spain Switzerland Taiwan Thailand United Arab Emirates United Kingdom United States Viet Nam	*
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