General Website Donation Form

Thank you for investing in FLY youth!

Donation Frequency

One time onlyMonthlyQuarterlyYearly

Your Information

First Name: *

Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/PostalCode: *

Phone:*

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Name on Card: *

Credit Card Number: *

Card Verification (CVV): *

Expiration Date: *

CardExpirationYear

Invoice Number:

Purchase Order Number:

Name: *

Reference Number:

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Double Your Donation

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I want my donation to be dedicated (optional)

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Please send an acknowledgement to the individual to whom I am dedicating my donation.

Email Address

Message to your recipient

What address should we mail the acknowledgement to?

Message to your recipient

Honor/Memorial Gifts

I want to dedicate my donation to someone:

In Honor Of In Memory Of Tribute To

In Memory Of:

Honoree Name:

Send Email acknowledgement to:

Send Postal Mail acknowledgement:

First Name:

Last Name:

Address Line 1:

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City:

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Country:

Dedication Message:

Terms & Conditions

Fresh Lifelines for Youth, Inc. (FLY) is a nonprofit public benefit corporation organized and operated exclusively for charitable and educational purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code. FLY’s taxpayer identification number is 52-2234595. FLY has provided no goods or services in return for this contribution, and all contributions to FLY are tax deductible to the extent permitted by law.

You will be charged:

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Advanced Redirect

The patron will be redirect to the following pages based on the authorized result.

Important Note:

The redirect pages have to be secure otherwise no redirect will occur.
If your server is offline for any reason the redirect will fail, resulting in error. If the patron experiences a page not found based on your server’s availability it may result to double charges

Use complete URL including https://

Success landing page * :

Declined landing page * :

The following URL parameters are included in the response and may be used on the landing page via custom programming:

Example Success URL:
https://yourpageurl.com/success-page?on=123456&result=success&response=authorized&t=totalamount&refid=referenceid&trk=tracker

on = OrderNumber
result = success
response = authorized
t = totalamount
refid = referenceid
trk = tracker

Example Decline URL:
https://yourpageurl.com/decline-page?on=123456&result=failure&response=dcl&t=totalamount

on = OrderNumber
result = failure
response = dcl
t = totalamount

Your donation:

Honor/Memorial Gifts

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Advanced Redirect

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