MAKE A SPECIAL CONTRIBUTION TO AHHA


Use this form if...
  • You are currently an AHHA member and wish to make an additional contribution.
  • You are not currently an AHHA member and wish to make a special contribution without becoming a member.
GENERAL INFORMATION:
Full Name:
Organization:
Street Address:
City:
State:
Zip Code:
Country:
Work Phone:
Home Phone:
Cell Phone:
Email:
Website:
This contribution is from an individual a company
ALL INFORMATION IS KEPT CONFIDENTIAL!

CONTRIBUTION INFORMATION:
AHHA is a designated 501(C)(3) nonprofit - Tax ID# 33-041271
Contributions are tax deductible as allowed by law
$ I support AHHA with this special contribution
Special Notes:
This area is provided to offer you an opportunity to send a special message to AHHA. Perhaps you wish to clarify something related to this contribution, such as designating your contribution towards a specific AHHA project. Or perhaps you wish to donate in honor of or in memory of a special person.

SUBMITTAL OPTIONS:
(Option 1) To pay by check, money order or credit card by mail...
Click here for form to download form, printout, complete and mail in.

(Option 2) To pay by credit card using online Secure Server...
AHHA accepts Visa, MasterCard and Discover
  • Fill in ONLINE on this screen all information requested above
  • Print out a copy of all of the above for your records
  • Click on "Click here to Pay Online" button below
  • You will be transferred to the Authorize.net Secure Server
Once you have transferred to the secure server, you will be asked to...
Enter Credit Card Number and Expiration Date
Under "Customer Billing Information"
Enter Cardholder Name and Billing Address for Card
If you enter your email address, you will receive an immediate email notification of your transaction from the credit card operation.
AHHA will acknowledge your credit card transaction by notifying you of the authorization code.

Online Payment Service