Donation
You may:
  1. Submit this form electronically and pay by credit card via our secure server from a link on the following page
  2. Fill out this online form and press the submit button. The information will be sent to your email account. Print out the email and mail it to Mercer Alliance along with your check.
 
Your information:
First Name:
Last Name:
Address
Line 2
City:
State:
Zip Code:
Daytime Phone Number:
E-mail Address:
Your gift WILL change lives!
$1,000 
$500  
$250  
$100  
$50  
$25  
Other   
Enclosed is a form for a Matching Gift from: (Name of Company)
(If submitting electronically, mail matching gift form to Mercer Alliance)

Please click the [Submit] button to send the contents of this form to Mercer Alliance. You will receive an e-mail confirmation, which you can print out and mail to Mercer Alliance with your check. You may also pay with a credit card or via your PayPal account from the page you will see after submitting this form.

 
 

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