Donation Form

 

Gift Information
Amount:	$2,500.00 $1,000.00 $500.00 $200.00 $100.00 $25.00 $20.00 $10.00 Other $     *
Select Your Frequency
Type of gift:	One-Time Monthly
Frequency:	Weekly Monthly Quarterly Annually Every 4 weeks On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending Date:   Ending:
Corporate:	This donation is on behalf of a company
Would you like to receive the Kesslers Diamonds Wish Bracelet Incentive:	No Yes
Would you like to receive the $500 Kesslers Diamonds Splurge Card:	No Yes
What station were you listening to?	B-93.7 Star 105.7 I wasn't listening to the radio *
Billing Information
Title:	Dr. Miss Mr. Mrs. Ms. Pastor Reverend
First name:		*
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