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Gift Information
Amount:	$     *
Designation:	Urban Farm Center Foundation Scholarships & Grants Fund Other
Other	*
Additional Information
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
Corporate:	This gift is on behalf of a company
Comments:
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Title:	Mr. Ms. Mrs. Capt. Chef Chief Col. Commander Dr. Father Judge Justice Mayor Pastor Rev. Senator Sister The Honorable
First name:		*
Middle name:
Last name:		*
Country:	United States Canada	*
Address lines:		*
City:		*
State:	<Please Select> 50 AA AE AL AK AB AS AP AZ AR BC CA CZ CN CO CT DE DC FM FL GA GU HI I ID IL IN IA K KS KY LA ME MB MH MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NL NC ND MP NT NS NU OH OK ON OR OT PW PA PE PR QB QC RI SA SK SC SD SP TN TX UT VT VI VA WA WV WI WY YT	*
ZIP:		*
Phone:		*
Email:		*
Confirm Email:		*
Payment Information
Cardholder's Name:		*
Credit Card Number:		*
Card Type:	Visa American Express Discover MasterCard	*
Card Expiration:	01 02 03 04 05 06 07 08 09 10 11 12  / 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043	*
Card Security Code:		*
Tribute Information
Honoree/Memorial Name:		*
First name:
Last name:		*
Type:	In Honor of In Memory of	*
Notes:		*
	Mail a letter on my behalf to	*

Note: If a designation for a gift is made to a non-existing fund, the funds will be redirected to the CLC Foundation Scholarships and Grants Fund. Please contact the Foundation office if you have any questions.