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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:
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Frequency:
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On:
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Monday
Tuesday
Wednesday
Thursday
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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:
*
Last name:
*
Country:
Argentina
Australia
Austria
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*
Address:
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*
ZIP:
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Phone:
*
Email:
*
You've chosen a one-time gift, would you like to make it a monthly gift instead?