Online Donation

Use this form to make an online donation. If this is for something specific, please note that in the comment box

Campaign

Palmetto Amputee Network

First Name*

Last Name*

Organization

Address*

City

Zip*

Country*

State

Phone*

Email*

Comment

Donation type

Onetime Recurring

Frequency

Number occurrences

Amount

$ 10.00 $ 20.00 $ 30.00 $ 40.00

$

Payment method

Stripe

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card type*

Card Holder Name*

INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201

PALMETTO AMPUTEE NETWORK 626 ASPEN ST FLORENCE, SC 29501-OOOO

DEPARTMENT OF THE TREASURY

Employer Identification Number: 82 -429927 0

DLN: 2605357 90 02 8 0

Effective Date of Exemption: April 12, 201,8 Contribution Deductibility : Yes