Monthly Donation Amount

$25

$50

$100

$250

Other

Recurrence Schedule

Monthly

Billing and Contact Information

First Name: *

Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/PostalCode: *

Phone:*

Full Name

Donation Details

Phone Type *

HomeMobileWork

I want my donation to be designated toward:

This donation is in Honor / Memorial

I want my donation to be dedicated in honor/memory of:

Acknowledgement

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

Acknowledgement Address (email or mail)

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:

Address Line 2:

City:

State:

Zip/Postal Code:

Country:

Dedication Message:

Payment Details

Credit Card

Routing Number: *

Account Number: *

Check Number: *

Account Type: *

Check Type: *

Name on Card: *

Credit Card Number: *

Card Verification (CVV): *

Expiration Date: *

CardExpirationYear

Invoice Number:

Purchase Order Number:

Name: *

Reference Number:

Monthly Charge Date (1st or 15th)

Charge me on: Payment will be processed and your card will be charged on this date

You will be charged:

Secured and Powered by Click&Pledge

Sustaining Single Parents

Our newest donor society honors our monthly recurring donors. A recurring gift of $15 or more (or $180/year) ensures that our program remains as resilient as the single parents we work for.

Belonging to the PowerCircle means you are sustaining single parents as they go back to school, earn degrees, and achieve self-sufficiency!

Whether you can afford hundreds or just a few dollars a month, your reliable contribution allows us to respond to Participant needs, throughout the year, and allows us to plan for the future and grow alongside our single parents, where they need us.

Loveland, Colorado:
375 West 37th St #150, 80538 | 970.635.5912

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

You will be charged:

Sustaining Single Parents

Advanced Redirect

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