On-Line Donations
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Donor Information
*
= required
Full Name
*
Affiliation
*
<Pick One>
Alumni
Current Parent
Grandparent
Parent of Alumni
Friend of School
Faculty/Staff
Other
Graduation Year
(4 digits, if applicable)
Address Line 1
*
Address Line 2
City
*
State/Province
*
Postal/Zip Code
*
Country
Daytime Telephone
*
Email
*
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 make a
one-time contribution of:
*
$
$100
$250
$500
Credit Card Type
*
<Pick Type>
Visa
MasterCard
Credit Card Number
*
CVV Number
*
Expiration Date
*
<Pick Month>
01
02
03
04
05
06
07
08
09
10
11
12
*
<Pick Year>
2018
2019
2020
2021
2022
2023
2024
2025
2026
Name on Card
*
Child's Full Name & Grade for Student Account
*
(if billed to Student Account)
Directed Donations
*
I would like this gift to be directed to:
Greatest Need - Please use my gift where it is needed most
Other
(Please Specify)
Special Instructions
Any special instructions we should know?
Thank You! Your receipt will be mailed to the above address.
Copyright © 2018,
Southridge School
and
Net Directories Inc.
