*Required fields
*Name:
*Address:
*City:
*State:
*Zip Code:
*Phone:
-
-
Email
(optional):
Please enter your credit card information below as it appears on your credit card.
*Credit
Card Type:
*Credit
Card #:
*Expiration
Date:
*Name
on Credit Card:
*Signature (required): ___________________________________
*Amount
of Donation:
$50.00
$100.00
$250.00
$500.00
$750.00
$1000.00
Other:
Please
fill out this portion, if applicable:
This
Donation is:
Name:
Please
send acknowledgement to:
Name:
Address:
City:
State:
Zip Code:
Thank You
AVDA
is a 501(c)(3) nonprofit charitable organization. Under the
Internal Revenue Code, your donation is tax deductible. A
copy of the official registration #SC-01783 and financial
information may be obtained from the Florida Division of Consumer
Services. Registration does not imply endorsement, approval,
or recommendation by the State. This organization retains
100% of all financial contributions received.
Fax your donation to:
Attn: AVDA
Fax Number (561) 265-2102
OR
Mail your donation to:
Aid to Victims of Domestic Abuse, Inc.
P.O. Box 6161
Delray Beach, FL 33482-6161
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