EmailMe Form - Donation to NAMI-Tallahasssee

Your information:

Your name and address information is important to the honoree or family, in order to write a thank you note or contact you regarding your gift.

It also helps us match your donation through our merchant account.

Your Name *

First Last

1. Your mailing address (should include street or P.O. Box, City, zip and state: *

Your Message to the individual or family:

We need to know, if you would like to include a message with your donation or how you would like to have the card signed. Examples: The Smith Family, John and Mary Smith.

Messages are limited to 200 words.

Would you like your email address included?

2. Honoree Acknowledgement:

Name and address of the family or individual you would like to receive acknowledgment of your donation. Your donation amount will not be included in the acknowledgement.

Who your gift is in "Honor" of or in "Memory" of:

Name of Honoree: *

First Last

Their mailing address (should include street or P.O. Box, City, zip and state: *

3. Payment:

This is a two-step process. Please confirm below that you have or will initiate the separate payment transaction. The information on this form is needed to ensure your gift is handled in a timely and accurate manner. Upon payment confirmation, we will proceed.

Mailing address to send verification of the donation if different from item #1 above. Particularly if it does not match your billing address. *

Confirmation of payment

I have or will complete payment, using the appropriate "Memorial/Honorium" button on the NAMI-Tallahassee donatation webpage.

Date of your online donation.

MM / DD / YYYY

The amount of your donation.

$ Dollars . Cents