Humane Heroes

Donor information

Campaign

Humane Heroes

First Name*

Last Name*

Address*

City*

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Zip*

Phone*

Email*

Is this gift a Memorial, Tribute, or General Cuddles Fund Donation?

This gift is in memory of (choose person or pet)

Gift is to honor (choose person or pet):

Is this gift a Memorial, Tribute or General Holiday Donation?

This Gift is a Memorial, Tribute or General Destination Donation

Name of Person or Pet

Is this gift a Memorial, Tribute, or General Donation?

Name of Person or Pet (if Memorial or Tribute):

Name of Person or Pet

Name of Person or Pet (if Memorial or Tribute):

Name of Person or Pet:

My Company will match my gift.

Name of company

Send Acknowledgement to: Name, Address, City ZIp

Send Acknowledgement to: Name, Address, City, Zip

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Comments/Notes

Is this gift a Memorial, Tribute or General Silver Paw Donation?

Name of Person or Pet (if Memorial or Tribute)

Person to be

Donation Information

Donation Type

One Time Recurring

Donation frequency

Number occurrences

Amount

$ 25.00

$

Payment method

Credit or Debit Card

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Expiration Date*

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Card (CVV) Code*

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Card Holder Name*

Online Donation

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Donation Information

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