GIVE THE GIFT OF HOPE
REGION FOR REQUEST
*
MONROE, LA
SHREVEPORT, LA
CROWLEY, LA
CLINTON, MS
UNDESIGNATED – Help Children & Families Across All Regions
How do you want to provide the Gift of Hope?
*
Sponsor a child's wish list
Make a donation
Become a collection site for new toys/clothing donations
How do you want to provide the Gift of Hope?
*
Sponsor a child's wish list
Make a donation
NUMBER OF WISH LISTS
*
REQUESTED GENDER
BOY
GIRL
REQUESTED AGE RANGE
0-2
3-5
6-8
9-11
12-14
15-17
WISH LIST COMMENTS
Use this section to clarify specific wish list requests (i.e. 3 year old boy, 5 year old girl, etc.)
NAME
*
First Name
Last Name
BUSINESS/ORGANIZATION
EMAIL
*
ADDRESS FOR COLLECTION BOX DELIVERY
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are there multiple locations associated with your business that will need a box?
*
Yes
No
Will the business disperse boxes or will they need to be delivered to the other addresses?
*
Bring all boxes to the above address-we will disperse boxes
Please deliver boxes to the other locations
How many boxes do you need to take to other locations?
*
Please type in additional addresses in need of a box
*
PHONE NUMBER
*
Format: (000) 000-0000.
RECEIVE TEXTS
*
YES
NO
Donation Amount
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( X )
USD
Description
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
COMMENTS
Submit
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