DONATION FORM - OneTime

Your generous gift will care for seniors today!

To make a one-time donation, which provides JCA with the ability to meet critical needs now, please complete this form.
Monthly giving provides JCA with a source of ongoing support we can depend on, and provides you with an easy way to budget your charitable giving. If, instead, you wish to make a monthly, sustaining donation, return to the Monthly Donation form.

Amount you would like to donate $*

$1000 $500 $250 $180 $100 $50

Other:

Your Name*

First Name

Last Name

Your Email*

We will send your donation confirmation by email.

Your Best Contact Number

Best number to reach you in case of any complications with your donation

Your Mailing Address

Address Line 1

Address Line 2

City

State

ZIP Code

Optional: How would you like us to refer to you in correspondence?

Other examples: The Hon..., Dr..., The Donor Family..., Is there an additional donor we should thank?

Optional: Does this payment go toward the fulfillment of a previous pledge?

No Yes

Do you wish to designate your gift to a particular JCA program?*

No Yes

Please consider unrestricted giving, which allows JCA to use your donation to match grant applications.

Designated Program*

Adult Day Centers and Caregiver Support Information & Referrals Intergenerational Programs Loaves of Love Senior Employment Senior Transportation

Would you like to dedicate this donation to someone?*

Yes No

Type of dedication:

In honor In memory

Make my donation in honor of:

Name of person or organization

Would you like us to send an acknowledgement of your gift to the honoree?

Yes No

How would you like us to deliver the acknowledgement?

Email Postal Mail

Honoree's Email Address

Honoree's Mailing Address

Address Line 1

Address Line 2

City

State

ZIP Code

Make my donation in memory of:

Would you like us to send an acknowledgement of this memorial gift to a friend or relation of the deceased?

Yes No

Tell us whom to notify:

How would you like us to deliver this memorial acknowledgement?

Email Postal Mail

Email Address of the Recipient - Acknowledgement of Memorial Gift

Mailing Address - Acknowledgement of Memorial Gift

Address Line 1

Address Line 2

City

State

ZIP Code

Optional: Please help us get to know you, our valued donor.

Credit Card Information*

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