Well-Spring Donation Page

WS LPC-color 2

Your Information

Name: * First Name Last Name
Email Address: *
Your receipt will be sent to this address
Phone: *
Organization:

Choose your donation amount

One Time
$

USD
Monthly
$

USD

Campaign:

Dedicate my donation in honor or in memory of someone

In honor of... In memory of...
Name
To whom is this donation dedicated?
First Name
First name of individual to be notified
Last Name
Last name of individual to be notified
Mailing Address
Street address of individual to be notified
Mailing City
City of individual to be notified
Mailing State
State of individual to be notified
Mailing Postal Code
Postal code of individual to be notified
Message
Message for dedication

Payment Method: *
Credit Card: *
Please provide the information as written on your credit card.

First name on card Last name on card
Billing Address: *
Please provide the address where your credit card statement is sent.

Street Address City State / Province / Region Postal / Zip Code Country

First Name

Credit Card #

Last Name

Address Line 1

Address Line 2

Cover the Transaction Fee

I'd like to cover all transaction fees for this donation so that 100% of my gift goes to Well-Spring.

Total: $ 0.00 USD

Fields marked with an asterisk (*) are required.

If you have questions, or if you would like information on tax-advantaged gifts such as appreciated securities, Qualified Charitable Distributions from an IRA, or grants from a donor-advised fund, please visit https://www.kintura.org/donate.aspx or contact:

Marisa E. Ray
Executive Vice President of Philanthropy
336.886.6553 ext. 5118
mray@kintura.org

Well-Spring Donation Page

Your Information

Choose your donation amount

Cover the Transaction Fee

Become a sustaining donor