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Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parish (Envelope) Number(Required)

If you do not know or have a parish envelope number please put ***

What is Your Donation For?(Required)

Who is this donation in memory of?

What is Your Donation For? Please Specify:(Required)

Notes

Donations must be from one person for tax receipt purposes. Please use the section above to note if the donation is from a family or in memory of someone.

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Card Details

Cardholder Name