Whitestone Community Ambulance Service Contribution Form



Whitestone Community Ambulance Service
A Volunteer Organization

Thank you your support. We’ve been serving the community of Whitestone since 1947.
The service operates 24 hours a day, 7 days a week and 52 weeks a year.
All members are entirely volunteer. Call us at (718) 767-1000


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.

*Gift Amount $:  .00
*Gift Frequency:

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

Donor ID #: 
(code from appeal mailing, if received)

 Individual   Corporate Contribution 

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


*Payment Type:   Credit Card   Check 
If by Credit Card:
If by Check: 
*Credit Card Type: 
*Credit Card #:  *Routing #:  Where do I find this?
*Exp. Date:  / *Checking Account #:  Where do I find this?

Comments:

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 e-mail confirmation will be sent to the e-mail address you provided.


About SSL Certificates


  
Whitestone Community Ambulance Service
A Volunteer Organization

12-15 150th Street • Flushing, NY 11357 • (718) 767-1000
www.wvac11357.com


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