Online Donation

Dietert Center

Helping others can always make you smile.
Please fill in all information that applies to the donation you are making.
Full Name*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
Phone Number*

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Donation*

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One time gift or monthly donation?*
Please specify what Dietert Center Program you wish to benefit:*

Greatest NeedNutrition/Meals on WheelsMeals on Wheels Pet PartnersTake 5 ClubDementia Care AdvocatesMedical Equipment LendingHandy Helper ServiceClub EdBuy a Brick ($50 each)
Brick Message: Enter the message EXACTLY as it will appear on the brick, up to 3 lines/12 characters per line including blank spaces and puncuation.
Line 1
Line 2
Line 3
What better way to honor or remember someone than to make a gift that supports the vital needs of our community?
My donation is in honor of:
My donation is in memory of:
Would you prefer that we notify someone about your gift? (Amount will not be disclosed)

Yes
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you would like to add a personal message on our notification, please type here (Space limited to 250 characters)
Any additional information you would like to share
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Dietert Center