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Your Name*
Prefix First Last
Spouse Name
Prefix First Last
Organization
I am donating as:
- An Individual
- An Organization
Address*
Street Address Address Line 2 City State ZIP Code
Your Birthday
MM slash DD slash YYYY

We want to celebrate you!
Phone*
Email*
Enter Email Confirm Email
Donation Amount*
Processing Fee
- Yes! I would like to cover the processing fee for this transaction.
- No, not at this time.
Fee Amount
Price: $0.00
Total
$0.00
(Optional) Comment
Credit Card*
Card Details
Cardholder Name
Donor Honor Roll*
- I prefer to have my name printed in the Donor Honor Roll.
- I prefer not to have my name printed in the Donor Honor Roll.
Receipt of Donation*
- Paper Please! I would like to receive a paper copy of my acknowledgement in addition to my digital acknowledgement.
- Save a stamp.! I would like to only receive a digital acknowledgement for this donation.
Honorariums / Memorials
- I am making my donation in honor or in memory of someone.
This gift is*
In honor of*
Prefix First Last
In memory of*
Prefix First Last
Message to Recipient (optional)
Would you like us to notify the recipient of your gift?*
- Yes, I would like the recipient to be notified
- No, notification is not necessary
Please notify the following person(s) of my gift*
First Last
Notification Method*
- Notify by Email
- Notify by Mail
Recipient Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

648 GRIFFITH ROAD, SUITE B | CHARLOTTE, NC 28217 | p 704.523.4333 | fax 704.523.5901 | contact@loavesandfishes.org