Donation Form

Your gift, your way

Every gift brings safe water within walking distance of one more family. Thank you for being part of it.

Your details

Full name

Phone — optional

Mailing address

Your gift

$25

Clean week

$50

A filter

$100

A family

$250

A well share

Other amount$

Frequency

One-time gift Monthly

Direct my gift to

In honor / in memory of — optional tribute

Payment

Card — enter only the last four; full number is captured securely

•••• •••• •••• Processed securely. Full card number and security code are never written on this form.

I've enclosed a check payable to Brightwater Fund

Donor signature

Date

Brightwater Fund is a registered 501(c)(3) charitable organization (EIN 81-0294417). Your contribution is tax-deductible to the fullest extent allowed by law; no goods or services were provided in exchange for this gift. A receipt will be mailed to the address above.