Donation Form

Health and Wellness Class Donation Page

The class you have registered for is partially funded through the Kent County Senior Millage. However, donations from participants are also vital to making sure the program can continue into the future. Please consider a suggested donation of $3 per class and feel free to make contributions for future classes at one time.

Payment

Amount

Type of Transaction

One Time Recurring

What class do you attend? Please include any additional information.

Contact Information

Organization?

First Name

Last Name or Organization Name

Address

City

State/Province

Zip/Postal Code

Home Phone

Work Phone

Payment Information

Payment Type

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code
Click here for CVV2 information

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

Privacy Policy
We take precautions to protect your information. We collect credit card or bank account information, names, addresses, and other data related to your transaction when you make a payment through our site. We use this information to process your payment.

Terms/Conditions
By submitting your payment, you authorize us to charge the account you provide for the amount you specify. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue a monthly pledge.

Senior Neighbors, Inc. • 678 Front Ave NW, Suite 205, Grand Rapids, MI 49504

(616) 459-6019 • [email protected]