Kroc Cares Enrollment

Every donation supports life-changing programs in Kootenai County.

All donations stay local and are 100% tax-deductible.
Kroc Membership Card #:
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
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I authorize the credit card on file ending in the last four digits may be used to start my donation.
Enter last four digits
I authorize the card that is used to process my membership dues to be used to start my donation.
By signing this form, I am agreeing to and understand the following: Donations are non-refundable, no goods or services have been provided in exchange for this donation, my first automatic payment is the first business day of the month, and to request to cancel this donation it must be submitted in writing by the 20th of the month to be effective for the following auto payment. Tax ID: 94-1156347
Signature
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