Use this secure
form to make your online credit card donation. If you prefer not to
transmit your card number via the Internet, please call our Business
Office at (662) 328-5704 ext. 101 with all of the necessary information.
If you are making
your gift by check, payable to Palmer Home for Children, please print out
the form and send it along with your contribution to:
Palmer Home for
Children
PO Box 746
Columbus, MS 39703
Your Information
Required fields are marked in red.
Last Name
Street Address
City
State
Zip
Daytime Phone
E -mail
Payment Information
Credit Card Type
Credit Card Number
Expiration Date
My Gift is in the amount of $
I would like this gift to be used:
Please indicate any special comments or requests below:
If you would like your gift to be a Memorial or Honor gift, Please also complete this section:
I would like this to be a:
Name of the person that this gift is in Honor or Memory of:
Name of the person/persons/organization this gift is from:
(This is the name that will be on the card as the giver of the gift)
Please inform the individual or family listed below of my gift: If you would like the card addressed to a family i.e. "The Smith Family" Please put that in the First Name block only and leave the Last Name block EMPTY
First Name
Last Name
Street Address
City
State
Zip
Make an in-kind donation, security donation or planned gift by contacting
Ed Waldron via telephone at
(662) 328-5704 ext. 114 or via e-mail at
A letter confirmation will be sent to you to acknowledge your donation.
Click on the Button Below to submit this gift to Palmer Home for Children.
Thank you for supporting Palmer Home for Children.
Privacy Statement:
Palmer Home for Children is committed to respecting your online privacy
and security.
We will not sell, rent or lease your personally identifiable information
to anybody.
