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Select Gift Amount:*

$30 - COVID Support
$150.00 - Freedom Level
$500.00 - Honor Level
$1000.00 - Liberty Level
$2,500.00 - Independence Level
$5,000.00 - Stars & Stripes Level
Other

One Time Donation Amount

If Other (or you wish to give additional monies), please enter the amount here. Donors at or above the Freedom level will receive a Veterans Count window decal and donors at or above the Liberty level will receive a Veterans Count lapel pin.

Billing Information

Type of card*

Business
Personal

Title

Name*

First Last

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Address*

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Email*

Yes, I would like to receive periodic updates and communications.

By checking this, you will be signed up for our monthly eNewsletter and communications about our work. You can unsubscribe at any time.

If this gift is from someone in addition to yourself, please enter their name below:

Joint Donor Title

Joint Donor Name

First Last

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Honor / Memorial Gift Information

Yes, this is an honor or memorial gift

Honor Type

Choose the memorial gift only if the person you are honoring is deceased.

Honoree Title

Honoree Name*

Notification Recipient Title

Notification Recipient Name*

Notification Recipient Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Message Body*

Message Closing*

Message Signature*

Include the gift amount in the message?*

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No

One time donation amount:

$0.00

Thank you so much for your donation to Veterans Count. Please note that Veterans Count is a fundraising program of Easterseals Maine, which is overseen by Easterseals New Hampshire. All funds raised in Maine will stay in Maine, so rest assured that we combine administrative efforts to save costs and pass that savings to our Veterans.

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Billing Information

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Honor / Memorial Gift Information

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