KindWorks, Inc.
Secure Payment Form
Donation Summary
Donation Date
Donation Amount
Purpose of Donation
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General Unrestricted Funds
Restrict Funds Use to Digital Empowerment
Restrict Funds Use to Food Security and Basic Needs (includes KindSoup)
Restrict Funds Use to Refugee Support and Home Setups
Restrict Funds Use to Summer Fun Stuff
Monthly Donation
-- Select --
Yes
No
Notes
Credit Card Information
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
Phone Number
Email Address
Shipping Information
Company Name
First Name
Last Name
Address
Address 2
City
State
Zip
Country
Phone Number
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