Donation Form Test - Apple Pay, PayPal, Square

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

How did you hear about Fair Haven?

Where would you like your gift to go?*

Would you like to make a one-time or monthly donation?*

One-time donation

Monthly donation- Fair Haven Caring Community

Enter your donation amount:*

This gift is in memory of:

This gift is in honor of:

(Optional) Please notify the following of my gift:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

An optional message to include:

How would you like to pay?*

Credit or Debit Card

Apple Pay or Google Pay

PayPal

Would you like to cover the processing fees?*

Yes, I want Fair Haven to receive the full value of my gift.

No, thank you.

Processing Fee Donation

Price: $0.00

Processing Fee Donation

Price: $0.00

Processing Fee Donation

Price: $0.00

Total

Credit Card*

Cardholder Name

Card Details

Payment Method

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Donation Form Test – Apple Pay, PayPal, Square