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Donation Form - With Tribute/Honor Fields

Donation Form - With Tribute/Honor Fields

Many of our nation’s paralyzed and disabled heroes need help accessing their much-needed benefits, medical care, and support services. With your monthly support, we will always be there to connect them to those life-changing resources.

My Donation

One-time

Monthly

Most give $24 monthly

$19

$24

$30

$35

Other

$25

$50

$100

$250

Other

Other

$

Minimum payment $5.00.

Other

$

Minimum payment $5.00.

Yes

Dedicate my donation in honor of or in memorial of someone.

Honoree Name

Occasion

Would you like to send an eCard?

No

Yes

Recipient First Name

Recipient Last Name

Recipient e-mail address

eCard subject

eCard message

Would you like to send a paper card?

No

Yes

Shipping First Name

Shipping Last Name

Shipping Address

Shipping Address Line 2

Shipping City

Shipping State/Province

Shipping Zip/Postal

Shipping Country

Payment Details

Payment Method *

Credit Card

PayPal

Bank Account

Apple Pay

Credit card number

Expiration date

CVV

PayPal

Routing Number

Account Number

Confirm Account Number

Account Type

Bank Name

Account Owner

My Information

First Name *

Last Name *

E-mail address *

Billing Information

Address *

Address Line 2

ZIP/Postal Code *

Country *

City *

State/Province *

By clicking SUBMIT your credit card will be securely processed.

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© 2024 Paralyzed Veterans of America. All Rights Reserved.
Paralyzed Veterans of America is a 501(c)(3) tax-exempt, non-profit organization.

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Help & Information

Is my donation secure?
The security and confidentiality of your information is our highest priority. We use industry-standard SSL (secure socket layer) technology to protect your information and provide a safe and secure environment for online donations. We will not sell, trade or share your personal information with anyone else, nor send donor mailings on behalf of other organizations.

Do I get a receipt?
A donation receipt will be sent to you at the email address you provide on this form. Please be sure to keep a copy of your receipt for tax purposes. If you select a recurring donation, you will be sent an individual receipt each month when your donation is processed.

Can I select my t-shirt size?
All t-shirts are size XL. When you receive yours, we'd love to see you wearing it! Tag your social media photos with #PVAHero.

To give by phone:
Please call us at 1-800-555-9140

To send in a check:
PVA National Processing Center
P.O. Box 758589
Topeka, KS 66675-8542