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:
You may designate this special, non-membership contribution towards a specific AHHA project or donate in honor of or in memory of a special person. Use this space to explain your wishes and provide AHHA any details.



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 and as back up in case of error in information transfer.
  • 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