Leisure World's Pool Campaign Donation Form for Camp TKT

Leisure World has taken on the challenge of raising funds for a swimming pool at Camp Ta-Kum-Ta in South Hero, Vermont. Show your support by making a donation to Camp Ta-Kum-Ta TODAY!!
Donation Levels 
  Level
    $2,500 
    $1,000 
    $750 
    $550 
    $450 
    $350 
    $250 
    $200 
    $175 
    $100 
    $75 
    $50 
* required information
Donation
Select Gift Frequency
I would like to make a one-time gift for the following amount:
:* $
I would like to make a recurring gift.
Gift Amount* # of Payments Payment Frequency Total Gift Amount
$ X = $
NOTE: This transaction will count as the first payment toward your total gift amount.
Donor Information
Title:
First Name:*
Last Name:*
Company Name:
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
Payment Information
Payment Method
:*
:*
:*   Explain
Credit Card Type:*
Credit Card Expiration:*
Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
:*
:
:*
State:
:
:*
Country:*
Additional Information
This donation is on behalf of a company.: Yes
No
Company Contact:
My employer participates in a Matching Gifts program.: Yes
No
I would like to make my gift:
Tribute Name:
Acknowledgee Full Name:
Acknowledgee Address:
Acknowledgee City, State, ZIP:
Type the characters you see in the picture below:*
By clicking Submit,
your credit card will be processed