Donations

Personal Information

* First Name:
* Last Name:
Company:
* Telephone:
* Email Address:

* Street Address:

* City:
* State:
* Zip Code:
* Country:

Donation Amount

ONE-TIME donation.
Recurring MONTHLY donation. (If you would like to become a monthly supporter, we can automatically debit your credit card on a monthly basis.)
* Amount:	$ (insert only numbers, ex: 100.00)

Payment Information

* Credit card type:
* Credit card number:
* Credit Card Expiration Date:
* Exact name on card:

Matching Gifts

Matching gifts are an easy way to increase your donation. Find out if your employer participates in our matching gifts program. If your employer offers a matching gift program, please complete the matching gift form (available from your employer) and submit to our office by fax 205-202-8862 or by mail to PADS 1919 Oxmoor Road #416, Birmingham, AL 35209.

If you know the following information regarding the matching gift, please complete.

Company Name:

Matching Gift Amount:

Name of Honoree/Occasion for Tribute/Comments

Spam Prevention Code:

* Enter Spam Prevention Code:

THE DSA COMMUNITY C.A.R.E.S.

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Matching Gifts