DONATION FORM - Monthly

Thank you for your generous, sustaining support!

When you become a monthly donor, you will help seniors thrive year-round.
Your monthly donation is also an easy way to budget your charitable giving.
In order that your donation adequately covers the cost of monthly credit card processing, please consider giving $15 or more per month, and elect a monthly payment in full-dollar increments.
Each January, JCA will mail you a summary of your annual giving, to use in tax preparation.

Amount you would like to donate monthly*

$100 ($1200/yr) $50 ($600/yr) $30 ($360/yr) $18 ($216/yr)

Other:

Date you would like to begin your monthly donations

Your Name as it appears on your credit card*

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 issues with your donation. We will NEVER call you to solicit donations.

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

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

Your Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

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 support grant applications.

Designated Program

Adult Day Centers and Caregiver Support Senior Employment Intergenerational Programs Information & Referrals 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 to begin to get to know you, our valued donor.

Credit Card Information*