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GENESIS WATERS

Gift Donation Form

   
Each donation in honor of a friend or loved one of $25 or more will receive a Christmas ornament and donation card.
Donation Date
Gift Donation Amount

Enter donation amount in two decimal format, for example 25.00

Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date

Enter expiration date as MM/YY

CVV2/CID
First Name
Last Name
Address
Address 2
City
State
Zip
Email Address
This can be mailed directly to the recipient of the gift donation or can come to you if you'd like to give to the recipient directly.
First Name
Last Name
Address
Address 2
City
State
Zip