Women's Way Secure Online Donation Form

Secure Server Form

I want to help WOMEN’S WAY provide much needed services to thousands of women and their families in the Delaware Valley.


Please note that fields with an asterisk (*) are required.

This form only accepts Visa, Mastercard and American Express cards.

PERSONAL INFORMATION

First Name:   *
Last Name:   *
Street or PO Box:   *
Apt/Floor/Suite Number:     
City:   *
State:    *
Zip Code:    *
Day Phone #:   *
Evening Phone #:     
Email Address:   *
Name of Employeer:     

You can select either a One-time or Monthly contribution. As Monthly contributor, your gift will be automatically transferred to Women’s Way until you stop or change the amount of your gift. A record of each contribution will appear on your bank or credit card statement. Of course you can stop your current contributions, at any time, simply by notifying Women’s Way at PH: 215-985-3322 FAX: 215-985-3369 or by Email

CONTRIBUTION INFORMATION

Contribution Amount (US$):  *  $  (No commas or spaces)
Contribution Frequency:  *

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


PAYMENT INFORMATION

Credit Card Type:   *
Credit Card Number:   * (No spaces)
Exp. Date:   * /

****Donations of $100 or more from women under 40 represent membership in the
Young Women’s Initiative. Select Yes if you are a woman under 40.

 Yes   No 
****Donations of $1,000 or more, exclusive of special events, represents
membership in the Lucretia Mott Society. Select Yes for more information.
 Yes   No 

If this gift is in honor or memory of a special person, please provide the information requested below:

In honor of:  
In memory of:  
Please notify:  
Address:  
City:  
State:  
Zip:  

If your company will match your contribution, please forward your contribution form to:
WOMEN’S WAY
123 South Broad Street, Suite 1399
Philadelphia, PA 19109

Please contact me about volunteering.  Yes   No 
I would like to designate WOMEN’S WAY as a beneficiary in my will.
Please send me more information.
 Yes   No 

A copy of the official registration and financial information may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.


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 credit card.
An email confirmation will be sent to the email address you provided.


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Women’s Way
123 S. Broad Street, Suite 1399 • Philadelphia, PA 19109 • Phone 215-985-3322 • Fax 215-985-3369 Email.



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