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CREDIT CARD DONATION FORM

Employee ID Number

Your Employment Entity

Title:

First Name:

Last Name:

Street 1:

City:

State:

Zip Code:

Email Address:

Phone:

Anonymous Gift

Yes, make this an anonymous gift

Designate Your Gift (up to 5 areas)

Please choose from one of the suggested total donation amounts below and select the program(s) that you wish to support. If multiple programs are selected, note that your total donation will be evenly distributed among those programs. If a program selection is not made, your donation will go to the LBH Fund. To make your donation to a program that are not listed, select "Other" from the drop down(s) then provide the details in the Other Program section.

President’s Club Membership = $260 and above

All donations made throughout the fiscal year (including Giving Campaign donations) will count towards becoming a member of the President’s Club.

Donation Amount (Exclude the $ symbol)

Other Program(s):

Payment Information

Total Donation Amount

Payment Type

Credit Card Number

Expiration

CCV

Thank you for supporting the 2024 Give to What You Love Campaign!

Questions? Contact Fallon Warwick, Donor Database Manager at 443-591-6435 | [email protected].