Your charity needs to have 501 (c) status and I will need a receipt for my taxes ($50 value).  Please only request a gift if you have direct knowledge that the charity wants this gift.

Your First and Last Name:  

Charity's Name: 

Charity Contact Name: 

Address of where to send the gift card:

I will be giving 3 gifts per month.  Is there a month you prefer to receive your gift? 

Your E-mail:

Brief Description of Intended Use for Gift Card: