Beaverton Activity Center Donation Form

Beaverton Activity Center Donation Form
"To accomplish great things, we must not only act, but also dream, not only plan, but also believe."

Anatole France
Name *

First Name Last Name
Email (A donation confirmation email will be sent to this address)
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Gift Amount *

50.00 100.00 250.00 500.00 1000.00 Other
My Gift is in Honor of: First Name Last Name
My Gift is in Memory of: First Name Last Name
Other: (Exp. Happy Birthday ....; Happy Anniversary ..... Congratulations... etc.)
- Please notify the following of this gift:
First Name Last Name Street Address Address Line 2 City State Zip
Additional Information

I would like information to include the Beaverton Activity Center in my will or estate planning I would like my donation to remain anonymous
Total
Thank You for your gift to the BEAVERTON ACTIVITY CENTER

Gift Amount:

USD Description

Debit or Credit Card Information
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year