This document is a donation form asking for either a monthly or one-time donation in the amounts of $200, $100, $50, $25, or $10, or another amount specified by the donor. It requests the donor's contact information including name, address, city, zip code, phone number, and email. It also has an option to volunteer time and thanks the donor for supporting GivingTuesday and the community with their donation.

1. Please accept my:
( ) Monthly or ( ) One time donation
In the amount of:
$200 $100 $50 $25 $10 Other _____
Name:
Address: City:
ZIP Code: Phone:
Email:
( ) I would like to volunteer my time
Thank You for supporting #GIVINGTUESDAY and the community
with your donation.