Heart to Hearts Donation Form - Children's Healthcare of Atlanta

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Field Is Required Select Gift Amount:

$20

$30

$50

$100

$200

Other:

Enter amount

Yes, automatically repeat this gift every month.

Additional Amount:

Opt-in to Cover Processing Fee:

I'd like to cover the 3% processing fee so more of my gift goes directly to Children's.

Company:

Yes, this donation is being made on behalf of a company.

If this is a company donation, please provide company name:

Company Street 1

Company Street 2

Company City

Company State

Company Zip Code

Yes, this is an honor or memorial gift

Honor Gift Type:

Honoree Title:

Honoree First Name:

Honoree Last Name:

Name who honor gift is from (as it should appear on card):

Message for honor/tribute gift (if you do not wish to include message, please type n/a)

Full Name of who to receive card:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Billing Information

Title:

First Name:

Middle Name:

Last Name:

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal Code:

Country:

Email Address:

Phone Number:

Yes, I would like to receive communication from this organization.

Payment Information

Payment Method:

Credit CardChecking Account

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Checking Account Information:

Bank Routing Number: What is this?

Bank Account Number:

Verify Bank Account Number:

Account Type:

Checking
Savings

By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.

Check Information

Frequently Asked Questions

Who do I contact with questions?

Where can I mail a donation?

Is my gift safe and secure?

What is a security code?

Will I receive a tax receipt?

Who do I contact to receive a tax receipt?

What is a monthly gift or a recurring gift?

Does Children's share my information with third party organizations?

How do I designate my gift?

What is an honor/tribute gift?

What is a company matching gift?

How do I make a gift of securities?

How do I put Children's in my will or part of my estate plan?

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