DONATION FORM

Phone: (757) 229-3306
Fax: (757) 229-3972

Thank you for your interest in Colonial CASA. Please fill in the fields below, then press "Submit My Donation."

This gift is from:

661-555-5555

Donation

Donation Levels

  1. Champion Club - Become a part of the Champion Club by donating $2,500
  2. Advocate Club - Become a part of the Advocate Club by donating $1,000
  3. Star Club - Become a part of the Star Club by donating $500
  4. Admiral Club - Become a part of the Admiral Club by donating $250
  5. Starfish Club - Become a part of the Starfish Club by donating any amount under $250
$10 $25 $50 $100 Other

Please notify the following person that this gift has been made to Colonial CASA

661-555-5555

Please check that all parts of the form above have been completed and then press "Submit My Donation" only once. The confirmation page will appear shortly afterwards. Then you will be able to proceed through paypal paying via Credit Card or Paypal account (not required for payment) to complete the process.

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