The ALS Association

Gift & Payment Information

If you would like to mail in your donation, click here for

our printable donation form.

1 Gift Information

Donor/Company Name(s)

all amounts are in USD

Field Is Required Select Gift Amount:

$50

$100

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$1000

$5000

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Note: $5 Minimum

Gift type:

One-time gift

Recurring Monthly Donation

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Total Gift: 0.00

Yes, this is an honor or memorial gift

Honor Gift Type:

Honoree First Name:

Honoree Last Name:

Notification Recipient Name:

Notification Recipient Street 1:

Notification Recipient Street 2:

Notification Recipient City:

Notification Recipient State/Province:

Notification Recipient ZIP/Postal Code:

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Yes, include the gift amount in the message.

2 Payment Information

Payment Method:

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Credit Card Information:

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Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Checking Account Information:

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Bank Account Number:

Verify Bank Account Number:

Account Type:

Checking
Savings

By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.

Check Information

3 Billing Information

Title:

First Name:

Middle Name:

Last Name:

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Street 1:

Street 2:

City:

State/Province:

ZIP/Postal Code:

Country:

Phone Number:

Email Address:

Yes, I would like to receive email communications from the Association.

Remember Me

Please confirm the information entered above before continuing. Click "Complete Donation" to complete your transaction of $0.00.

Please only click the Complete Donation button once to avoid multiple charges. This may take a few moments.

The ALS Association Greater New York Chapter is a qualified 501(c)(3) tax-exempt organization and donations are tax-deductible to the full extent of the law. No goods or services were provided for this gift. Please consult your tax advisor regarding specific questions about your deductions.

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