Signing Up To Donate Water
Name of Organization
Name
First Name
Last Name
Contact Email
example@example.com
We accept donations of either a water pallet or the equivalent monetary value ($500). Which donation type will you be making?
Water Pallet
Monetary Value
One pallet of water, or the equivalent monetary value of $500, covers our neighbors for one month. How many months would you like to sponsor? Pallets can be donated over time as we need 1 per month.
1 Month
4 Months
6 Months
12 Months
Other
Submit
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