Care Moses Lake Recurring Donation Form
Donation Options
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Recurring Donation
$
5.00
for each
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Recurring payments
Recurring Donation
$
10.00
for each
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Unlimited
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Recurring payments
Recurring Payment
$
25.00
for each
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Unlimited
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Recurring payments
Recurring Donation
$
50.00
for each
month
Unlimited
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Recurring payments
Recurring Donation
$
75.00
for each
month
Unlimited
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Recurring payments
Recurring Donation
$
100.00
for each
month
Unlimited
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Recurring payments
One Time Payment
$
500.00
one-time payment
One Time Payment
$
250.00
one-time payment
General Donation
USD
one-time payment
Name
*
First Name
Last Name
Business Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Submit
Should be Empty: