Disaster Relief Form

This form is for the benefit of storm victims and will be allocated to the Florida Elks Disaster Relief fund. Please note: members and lodges will not receive Harry-Anna Trust Fund credit for this gift.

PLEASE READ:
- Please use a computer to complete this form. Mobile devices such as phones and tablets may cause an error when inputting your information.
- Enter the amount by using the "Custom Amount" field to type an amount.
- Lodges and Districts who are giving, please use the lodge/district name on the entire form, not your own. This will ensure the system does not "attach" the gift to your personal record.
- CLICK THE GIVE BUTTON when you have completed the form.
- Error messages are shown at the top of the page.
- When you click the "GIVE" button, you will receive a success page AND a confirmation email. IF YOU DO NOT RECEIVE THESE, PLEASE CHECK YOUR SPAM FOLDER, then email Fundraising@floridaelks.org to verify.

One-time Donation to Disaster Relief

Custom One-time Donation Amount

Contact Info

First Name (or Organization, Lodge or District Name)

Last Name

Country

Address 1

Address 2

Postal Code

City

State/Province

Phone Number

Email Address

Payment

Card Number

Card Type

Expiration Month

Expiration Year

Name On Card

CVV Code

Account Number

Routing Number

Name On Account

Account TypeCheckingSavings

Billing Address 1

Billing Address 2

Billing Postal Code

Billing City

Billing State

Billing Country

Donations to the Florida Elks Charities Disaster Relief fund are tax-deductible to the extent that the law allows. No goods or services were provided in exchange for your donation.

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION FOR FLORIDA ELKS CHARITIES, INC. CH1842 MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.