griefHaven Donation Page with Check

Please fill out this form with your information

if you wish to honor or memorialize someone and donate with a check. You will find the mailing address to send the donation check on the thank you page after you submit this form.
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email*
example@example.com
Donation Amount*
Memorial Information

You may click none, one or both boxes:
This donation is in honor of someone (meaning this person is alive and you are honoring them).
This donation is in memory of someone (meaning this person is not alive and you are remembering them).
Please input the name of the person you are honoring.

First NameLast Name
Please input the name of the person you are remembering.

First NameLast Name
Select Gift Notification Method
No NotificationEmailPrinted CardMemory Tile
Person we will notify of your donation – Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Your personal message that we will deliver with your gift notification
Memory Tile
Your donation will result in a beautiful memory tile being placed on our website, and we would like to know what you would like that memory tile to say.

Most people say either (1) In loving memory of..., (2) In honor of..., (3) In loving memory of... and in honor of... (meaning that they do both).

Here are some examples:
(1) In loving memory of my beautiful child, Shane Gray Meller,
(2) In honor of the Meller family,
(3) In loving memory of my beautiful child, Shane Gray Meller and in honor of the Meller family.
In loving memory ofIn honor ofBoth
Name of person(s) you would like to honor
Personal message you would like put on the memorial tile:
Please indicate any special instructions for your memory tile - background image, font, colors, ect.
Should be Empty:

Please fill out this form with your information

Memorial Information

Select Gift Notification Method

Memory Tile