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Home » Lights of Love 2011

Lights of Love 2011

1. Please select number of gifts:

Gift 1:

My gift is:  In honor of:   In memory of:   

Please notify the family at: (amount not disclosed):
Name: 
Address: 
City:    State:    Zip: 

Please Select Your Lights of Love:

Outdoor Tree Lights   per person $25.00   =   $0.00
Indoor Tree Lights: Entire Tree $1,000.00  
Indoor Tree Lights   per person $25.00   =   $0.00

2. Payment Amount

Gift Total:

Additional Donation Amount:

Total Payment Amount:500

3. Contact Information:

Email: 
Title:   *First Name:    *Last Name: 
Phone Number:  (xxx)xxx-xxxx
*Address: 
*City:    *State:    *Zip: 

4. Billing Information: Same as Contact Information

5. Payment Information:

 Credit Card  PayPal

Credit Card: 
Card Number: 
Expiration:    Month:    Year: 
Security Number:    (Last 3 digits in signature area on back of card or for American Express 4 digits on front)

You will receive an email confirmation for your records, if you provide an email address

 

*For assistance, call 202.895.0160 or send an email.





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