S.H.I.N.E. Donation Form
Please fill out the form below to donate to our fundraising drive. All donations are tax-deductible. Tax ID: 87-1024593
Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
I am donating to S.H.I.N.E. as a/an
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Student
Individuals enrolled full-time in an educational institute
$
25.00
Quantity
1
2
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10
Individual
A single person
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Family
More than one person contributing together
$
85.00
Quantity
1
2
3
4
5
6
7
8
9
10
Sustainer
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Friend
$
300.00
Quantity
1
2
3
4
5
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7
8
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10
Patron
$
500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Benefactor
$
1,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Payment Method
Please Select
Credit Card
Check
Cash
Frequency of Payment
One-time
Monthly
Quarterly
Yearly
Preferred Contact Method
Email
Phone
Mail
Date
-
Month
-
Day
Year
Date
Additional Comments
Signature
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