Holiday Hero On-Line Donation
 
Anonymous Donors: If you are making an anonymous donation: Select the Anonymous box under the Donor Information Section and complete the Credit Card Information section.
 
Please complete the form below to make your Holiday Hero donation.
If you encounter problems using the online donation screen, please send an email to cmoll@cetechnology.com
 
Fields with an asterisk (*) are required.
Donation Information
Categories
Diamond.... ...$500.00 or more.
Gold................$100.00 to $499.99.
Silver.............$50.00 to $99.99.
Bronze..........$25.00 to $49.99.
Donation (US Dollars):* $  
Select one of the following:*
Publish my name, or organization in the announcement as follows (40 char limit):  
OR In memory of (40 char limit):(eg. Our daughter Kris / Bob and Theresa Mullins):  
OR I want to remain anonymous, do not publish my name/organization:  

Only contributions of $25.00 or more will be listed in Business First unless indicated by anonymous notation above. AROCC will have sole discretion as to placement and layout. All donations will be acknowledged and are greatly appreciated.
Deadline for ad placement to assure publication must be received by Friday, December 14th , 2007.

Credit Card Information
Credit Card Type:*
Credit Card Number:*  
Expiration Date:*
Name as it Appears on Card:*  
Contact Information
Individual or Company:   
Salutation (Mr.,Mrs,Etc.):*  
                   
Name(First/MI/Last):*   / /      
Address Line1:*    
Address Line 2/3 (if any):   /
City/State: *   /
Zip: *  
Phone:   (H)  (W)
Email:*