Secure Donation


Secure Online Donation:

Items with * in front of them are required.

*First Name:
*Last Name:
*Address:
*City:   *State:   *Zip:
*Email:
*Daytime Phone:
 
I wish to remain anonymous.
 
I would like to be contacted about volunteering.
 
Please forward my donation to this affiliate program of Georgia CASA:

 
*In the amount of:
 $10,000
 $5,000
 $2,500
 $1,000
 $500
 $250
 $100
 $50
Other: $
 
I would like to repeat this donation automatically at the following interval:
 Monthly
 Quarterly
 Semi-annually
 Annually
 One time only
 
This donation is In Memory of:
 
This donation is In Honor of:
 
Please Notify:
(name and address)
 
My donation is specifically for:
 
Matching gift from:
 


Your gift is tax deductible to the full extent allowed by law.

Thank you for supporting Georgia CASA!