Adopt A SeniorDonation Form "*" indicates required fields Your InformationName* First Last Email Address* Phone #*Adopt a SeniorDiamond Sponsor Quantity Price: $75.00 Quantity $75 can purchase a full gift bag for a senior in a need.Gold Sponsor Quantity Price: $30.00 Quantity $30 can be used to buy a book of stamps, towel set and toiletries for a gift bags for a senior in need.Silver Sponsor Quantity* Price: $10.00 Quantity $10.00 Can be used to purchase a set of towels or toiletries for a gift bag for a senior in need.Payment InformationProcessing Fee: Make my purchase go further. Please increase my purchase total to help cover credit card processing fees. Processing Fee Price: $0.00 Total Amount To Be Charged: Credit CardCard Details Cardholder Name Billing Address* Street Address City State / Province / Region ZIP / Postal Code
