Christmas Gift to Habitat

If your gift is in honor of somebody else, please feel free to fill out the optional information below with the honoree's name and address so that we can mail them an acknowledgement of your gift.

Yes I'd like to donate

Total Amount

Donor Information

First Name *

Last Name *

Company Name

Street Address *

City *

State *

Phone

Email *

Donation Note, Optional

Honoree Name

Honoree Street Address

Honoree City

Honoree State

Honoree Zipcode

Credit Card

If you have a PayPal account, you can click the PayPal button to continue. Otherwise, fill in the credit card and billing information on this form and click Continue at the bottom of the page.

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Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *