This is test copy. We can echo language on the piece in this area, and can apply formatting if needed to make it interesting. The header photo can also be changed out, but needs to be something that works well wide. Donor Information First Name Last Name Home Address City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Email Address Phone Number Credit Card Donation Would you be willing to cover the 3% online processing fee? Yes No Frequency of Your Donation One-Time Donation Recurring Donation (monthly) Recurring gifts will occur perpetually until you notify our office to stop payments. You may provide special instructions in the "Donor Notes" field below. One-Time Amount $500 ($515 charged) $250 ($257.50) $100 ($103 charged) $50 ($51.50 charged) $25 ($25.75 charged) Other… Amount $ Monthly Recurring Amount $250/month ($257.50/month charged) $100/month ($103/month charged) $50/month ($51.50/month charged) $25/month ($25.75/month charged) $10/month ($10.30/month charged) Frequency of Your Donation One-Time Donation Recurring Donation (monthly) Recurring gifts will occur perpetually until you notify our office to stop payments. You may provide special instructions in the "Donor Notes" field below. One-Time Amount $500 $250 $100 $50 $25 Other… Amount $ Monthly Recurring Amount $250/month $100/month $50/month $25/month $10/month Donor Notes Payment Information Update Submit Leave this field blank