Vital Grace Donation Form

Is this donation on behalf of a individual or a business? *

Individual Business

Donor Name *

First Name Last Name

Company Name *

Company Point of Contact Name *

First Name Last Name

We would love to send you special thank you gifts through the year for your contribution.

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Company Phone Number

Contact Phone Number

Email *

example@example.com

Type of Donation *

Amount *

$5 $10 $50 Other

Total

Donor Notes

How will you be paying?

Credit Card Check Debit Card

Donation

USD Thank You!

Credit Card Details - Care information will not be stored.
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Mailing Details for a Check Donation

Please make all checks payable to:

The Vital Grace, Inc.

c/o: Finance Department

3138 Maple Rd.

Lindale, GA 30147

Once we receive your check, we will send a confirmation email with your receipt.

Please verify that you are human *

The Vital Grace, Inc. Donation Form