East Hampton Food Pantry Donation Form

Donation Levels 
  Level
    $1000 
    $500 
    $250 
    $100 
* 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
First Name:*
Last 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 (Optional)
Who are you sponsoring for this event?:
Would you like to volunteer your services?: Yes
No
Are you interested in sponsoring a food pantry event/fundraiser?: Yes
No
Are you a student looking to fulfill your community service hours?: Yes
No
Would you like information about underwriting Pantry Programs?: Summer lunch
Thanksgiving
Other holiday distributions
Pantry logo items (ie: t-shirts,aprons,hats or paid positions)
Are you interested in becoming an active member of our Board of Directors?: Yes
No
A receipt will be sent to the email address provided.
By clicking Submit,
your credit card will be processed