Call Center Form







Gift Information

Each donor will be mailed a notecard, which they may use as a gift to honor someone else (i.e. “A donation in your honor has been made to the 44 Cent Cure.”)
  • If a caller asks to have an honorary gift notecard shipped to someone else, add that name and address to Gift Comments.
  • If a caller asks for extra honorary gift notecards (e.g., they want to honor more than one person) indicate how many total cards needed in Gift Comments.
  • If a caller does not want an honorary gift notecard, please indicate that in Gift Comments.

Your Information

Legal first name

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Payment Information

Only monthly recurring gifts can be deducted directly from a US bank account. Please select Monthly Gift Type and United States to use your bank account.

We currently only setup recurring monthly gifts on the 5th and 20th of the month.
We currently only setup recurring monthly gifts on the 16th of the month for Canadian dollar gifts









Total
You are signing up for a recurring gift. This amount will be charged once now, then the charge will recur on the date you selected above.