Randolph Co Humane Society

Providing safe and proper fitting harnesses for newly adopted dogs.

Donation

Frequency

($15 buys one harness)

Payment

Credit CardACHPayPalOneClick

Name On Card

Card Number

Card Type

Expiration Month

Expiration Year

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

Contact Info

First Name

Last Name

Country

Address 1

Address 2

Postal Code

City

State

Email Address

Yes, I would like to receive email communications. (Unchecking this box will remove you from our email subscription list.)Yes, I would like to receive email communications. (Unchecking this box will remove you from our email subscription list.)

Other

Tribute Info

Tribute Type

Please indicate the Tribute Name below and how you would like to share with the family that we have received a gift in tribute to their love one - either by email or regular mail

Tribute Name

Please provide family contact information below

Family Contact First Name

Family Contact Last Name

Acknowledgee Address 1

Acknowledgee Address 2

Acknowledgee Postal Code

Acknowledgee City

Acknowledgee State

Acknowledgee Country

Family Contact Email Address

Personal Message

Please check the box below.