Online Subscription Form | Credit Card Payments for Donations: Color A Smile

Recipient Last Name

Recipient First Name

Address (Line 1)

Address (Line 2)

City

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Choose how many drawings we should mail each month

2 drawings per month: * * Mailed to individuals * * $20.00 suggested donation
10 drawings per month: * * Mailed to Activities Directors or Military Personnel * * $35.00 suggested donation

Your Last Name

Your First Name

Your E-mail Address

Donation Amount

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Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

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