DONATION FORM
Thank you for your generous support!
Supporting children, teens, adults, and families following the death of a loved one.
1) Donor Information
Name
Address
City/State
Phone
Email
Zip
2) Donation Type - Mark all that apply
( ) Sign me up for monthly giving at $
#months
Start date:
/
Exp date:
/
/
( ) I would like to make a one-time gift of $
( ) Enclosed is my check payable to The Moyer Foundation
I prefer to contribute by (select card type): ( ) VISA ( ) Mastercard ( ) American Express
CARD#
Name as it appears on card:
/
Signature
3) Direct my donation – Please direct my gift to the following programs/initiatives.
( ) GREATEST NEED– Please direct my gift to helping where help is needed the most.
( ) ANNUAL HEAL YOURSELF - ‘ONE NIGHT ONLY’ EVENT
( ) GRIEF RELIEF FUND
( ) PROJECT 1225
4) Tributes
This gift is made ( ) in honor of ( ) in memory of
The Gifts From Jada Foundation will send out a personal tribute card to whomever you designate to let them know they have been remembered in
this most meaningful way.
Please send acknowledgement of this gift to:
Name
Address
City/State
Zip
Additional Options (mark all that apply)
( ) My employer will match this gift – enclosed is a matching gift form.
( ) I would like to make a gift of stock. Please contact me with instructions.
( ) Please send me information on how to include The Gifts From Jada Foundation in my will / planned giving.
( ) Please send me information on becoming a volunteer.
Please send completed forms via fax to (954) 800-7186 OR mail to: Gifts From Jada Foundation - 10811 NW 34th Place - Coral Springs, FL 33065