Dutchess Day School On-Line Donations

On-Line Giving

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Donor Information

= required

Full Name *

Affiliation *

Year of Graduation

(4 digits, if applicable)

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

Daytime Telephone *

Email *

What prompted you to make this gift?

Recognition

Please indicate how you would like your name(s) to be recognized in our Donor Listings.

I wish for my name to remain anonymous

Credit Card Information

I would like to contribute:

Total Donation Amount (US$) *

Credit Card Type *

Credit Card Number *	Verification Code *
Expiration Date *	*
Name on Card *

Directed Donations

* I would like this gift to be directed to:

$ Dutchess Day Fund
$ Yearbook Advertisements
$ (Please Specify)

Matching Gifts

Please indicate whether your employer or your spouse's employer will match your gift.

	Yours \|	Spouse \|	Organization Name(s)
Yes, matching form will be sent later
No, matching not available

Please fax your form to Eileen Shaw at 845-677-6722 or mail to Eileen Shaw, Interim Director of Development, Dutchess Day School, 415 Route 343, Millbrook, NY 12545.

In Honor / Memory of

I would like this gift to be in Honor / Memory of:

Name(s)

In Honor In Memory

Please send an acknowledgment of my gift to:

Name

Address

Special Instructions

Any special instructions we should know?

Thank You! Your receipt will be mailed to the above address.