Cleary Foundation for the Deaf Secure Online Donation Form



Secure Online Donation Form

Please note that fields with an asterisk (*) are required.
For your security, this form will not work if you use the AutoFill feature in your browser.

For a printable form, please click here.

*Please use this gift for: 
*Please indicate gift frequency: 
*Gift Amount:   $  .00

If you choose a monthly frequency, please choose the date you would like for us to charge your account:

*First Name:  *Last Name: 
*Address 1:  Address 2: 
*City:  *State: 
*Zip Code:  *E-mail: 
*Daytime Phone #:  Evening Phone #: 

May we contact you at your e-mail address?  Yes   No 



*Credit Card Type: 
*Credit Card # : 
*Exp. Date:  /

After ensuring that all of the information above is correct,
please click the Submit Form Now button ONLY ONCE.
Multiple clicks of the Submit button will result in duplicate charges to your account.
An email confirmation will be sent to the email address you provided.

 


  
Cleary Foundation for the Deaf
301 Smithtown Blvd. • Nesconset, NY 11767-2077 • Phone: 631-588-0530


Untitled Page