Anne Grady Services - Monthly Donations Form

Thank you! Your donation to the Anne Grady Foundation will help us provide dignity, respect, and quality services to individuals with intellectual disabilities.

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Monthly Donation Amount*

Would you like to increase your monthly donation by 3 percent to help offset our credit card processing fees?*

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Calculated Monthly Donation Amount

Final Monthly Donation Amount*

Monthly Donations(USD for each month)

Enter an amount to be charged to your credit card each month.

Total $0.00

Email

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Mobile or Home Phone Number*

Work Phone Number

E-mail*

Organization (if applicable)

My donation is designated for:

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Dedication

(to give your gift in honor or memory of someone)

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Make Monthly Donations