Legacy Wall Form

Legacy Wall Form

We are excited to have you create your Legacy.
Donor Information
Company/Individual *
How do you want to be recognized on wall?
Contact person*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
Legacy Wall Details
Legacy Wall Levels
- $2,500 - $4,999 yearly investment Bronze Heart
- $5,000 - $9,999 yearly investment Gold Heart
- $10,000 - $24,999 yearly investment Steel Heart
- $25,000 - $49,999 yearly investment Garnet Red Heart
- $50,000 and up yearly investment Branded Artwork (donors choice)
I/We will pay with a:*

One-time donationYearly donationMonthlyOther
I/We agree to give a one-time donation of $Dollar amount for the heart shaped leaf color level.
I/We agree to give a yearly donation of $Dollar amount for a minimum of three years, totaling $Dollar amount for the heart shaped leaf color level.
I/We agree to give a monthly donation of $Dollar amount for a minimum of three years, totaling $Dollar amount for the heart shaped leaf color level.
I/We agree to give a donation of $Dollar amount for a minimum of three years, totaling $Dollar amount for the heart shaped leaf color level.
I/We will pay with a:*

One-time lump sum paymentYearly paymentsMonthly payments
Please select one of the following:*

I will be submitting a check for payment no later than date listed below.Credit CardOther (please add details to comment section below)
Once the form has been submitted, If you selected credit card as the form of payment, you will receive a Thank You email that contains a link to pay online or set up payments if recurring is selected.
Payment will be received by: *

MonthDayYear
Date
Clear
Date*

MonthDayYear
The Ronald McDonald House Charities of Southern Colorado is a 501 (c)(3) Not-For-Profit Organization. All donations are tax deductible to the extent allowed by law. EIN #: 84-1013843. Please retain a copy of this form for your tax records.
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Legacy Wall Form

Donor Information

Legacy Wall Details