Dragonfly Forest Website Donation Form

* 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:
How did you hear about us?:
Payment Information
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:*
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:*
Matching Gift Information
Will this donation be potentially matched?
If you know the following information regarding the matching gift, please complete.
Company Name:
Matching Gift Amount:$
Donation Direction
Where would you like your donation directed?:
Donation Made:
First Name:
Last Name:
Name to Mail Card:
Address to Mail Card:
Address 2 to Mail Card:
City to Mail Card:
State to Mail Card:
Zip Code to Mail Card:
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The official registration and financial information of Dragonfly Forest, Inc., may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.
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