Donation Form for AFLH Group Homes

Donation Form for AFLH Group Homes
Donor Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Company Information
Company Name
Company Type

For-ProfitNon-Profit
Company Address
Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Donation Details
Donation Amount*
Donation Type*

One-Time DonationMonthly Recurring DonationSponsor a Resident
If sponsoring a resident, preferred duration of sponsorship
Payment Information
Cardholder Name*

First NameLast Name
Credit/Debit Card Number*
Expiration Date*

MonthDayYear
Date
CVV*
Billing Address
Address 1*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Notes
Message or Dedication (e.g., "In honor of," "In memory of"):
Would you like to receive updates on how your donation is used?*

YesNo
For more information about how your donation will be used or to discuss partnership opportunities, please contact us at (614) 808-1011 / (614) 706-7388 or email us at info@aflh.org.
Should be Empty:

Donor Information