donation

1 I Want To Give

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My Gift Total:

Donation Frequency:

One-time donation Monthly recurring donation

Donation Frequency:

One-time donation Monthly recurring donation

Several months:

2 Personal Information

*First Name

*Last Name

*Email

*Phone

Company Name

*Address

*City

*State/Province

*Zip/Postal Code

*Country

If your donation is for a Shalva event please specify which

This is an honor or memorial gift

Honor Gift Type:

Honoree First Name

Honoree Last Name

Name of Person to Notify

Address

City

State/Province

Zip/Postal Code

Country

Message to Person/Family:

3 Credit card number will be inserted after this form is sent

3 My Payment Information

*Card Owner First Name

*Card Owner Last Name

*Card Number

Expiration Date

Expiration Year

*Verification Code:

Gift Aid
At no extra cost to you, Shalva can increase your gift by 25p for every £1 you donate using Gift Aid.
Gift Aid is reclaimed by the charity from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer.

In order to Gift Aid your donation please tick the box declaring
I want to gift aid my donation and any donations I make in the future or have made in the past 4 years. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

Yes, I would like to receive the latest updates from Shalva.

Inspire Hope. Change Lives.

1 I Want To Give

2 Personal Information

3 My Payment Information