Easterseals Southern Georgia Disaster Relief donation form

Donate to Easterseals Southern Georgia today

Help Easterseals families impacted by Hurricane Michael

Donate $30 or more to help us send relief, aid and care to as many people affected by Hurricane Michael as possible.

Giving a monthly donation is the best way to make an impact. You may cancel or change this monthly donation at any time.

Additional Amount:

I would like to make this gift in honor or memory of someone special

Honor Gift Type:

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Honoree Name:

Notification Recipient Information

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Notification Recipient Name:

Notification Recipient Street 1:

Notification Recipient Street 2:

Notification Recipient City:

Notification Recipient State/Province:

Notification Recipient ZIP/Postal Code:

Message to Notification Recipient

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Message Closing:

Message Signature:

Yes, include the gift amount in the message.

Billing Information

First Name:

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Street 1:

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Mobile Phone Number

Payment Information

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Credit Card Information:

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Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Checking Account Information:

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Bank Account Number:

Verify Bank Account Number:

Account Type:

Checking
Savings

By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.

Check Information

I would like to cover the credit card fee so 100% of my gift goes to Easterseals.

Credit Card Verification Code

The Verification Code is imprinted on credit cards to help merchants verify transactions when the actual card is not present, such as Internet purchases or donations. The merchant uses this number as part of the authorization process with the card issuer.

Visa, Master Card, and Discover:

The verification code for Visa, Master Card, and Discover is a 3-digit number printed on the back of your card. It appears after the account number or last 4-digits of your account number, in the signature panel.

American Express:

The American Express verification code is a 4-digit number printed on the front of your card. It appears above and to the right of the embossed account number.

Easterseals Southern Georgia
1906 Palmyra Road, Albany, GA 31701 | 229-439-7061
Tax ID: 58-1915733
Easterseals and its affiliate organizations are 501(c)(3) nonprofit organizations.

Easterseals Southern Georgia
1906 Palmyra Road
Albany, GA 31701 | 229-439-7061
Tax ID: 58-1915733
Easterseals and its affiliate organizations
are 501(c)(3) nonprofit organizations.