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Honor & Remember Gift

Thank you for choosing to donate to the Lollypop Farm in honor or in memory of someone special. Please use the form below to use your credit card to make a donation online, call us at 585-223-1330 x240, or download the printable form and mail in your donation.

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* required information
Donation Information
:* $
Donor Information
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
ZIP/Postal Code:*
Payment Information
:*   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:
Memorial / Honorarium Information
Please select the type of gift and indicate the person or pet to Honor/Memorialize. Please put pets' names in quotes. e.g. "Fluffy." In addition, please enter the name and address of the person to send acknowledgement to.
Select type of gift:*
Name of Person or Pet to Honor/Memorialize:*
Acknowledge to Name:*
Acknowledge to Address:*
Acknowledge to City:*
Acknowledge to State:*
Acknowledge to Zip:*
Your personal message:
By clicking Submit,
your credit card will be processed

Lollypop Farm

99 Victor Road; Fairport, NY 14450
Phone: 585-223-1330 | Fax: 585-425-4183
Animal Cruelty 24 Hour Hotline: 585-223-6500

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