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Aish of the Rockies Online Donation Form

I Want to Give:
I Want to Give:*
- $2500
- $1000
- $500
- $250
- $180
- Other
Other
$10 is the minimum online donation. All donations are tax deductible.
Please enter a number greater than or equal to 10.
Product Name
Price: $0.00 Quantity:
Frequency:
Frequency*
- Once
- Monthly
I Want to Support:
I Want To Support:*
Dedication Details
Program Choice
Other Support
Personal Details
Name*
First Last
Email*
Phone*
Address
Street Address Address Line 2 City State ZIP
Additional Comments
Credit Card Information
Credit Card

American Express
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Card Number Expiration Date Security Code Cardholder Name
Total
$0.00
* Please note: Your selected donation amount will be made today and on the 07th of each following month using the payment method selected. You may cancel or change this amount at any time by calling our office.

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