Donation Form | United Senior Services

Contact Information

Name(s)*

Phone*

Email*

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Address*

Street Address Address Line 2 City State ZIP Code

Please choose "yes" if you would like your gift to remain anonymous.

All gifts to USS are tax deductible. USS is a 501c3 organization.

Donation Amount*

Is the a one-time donation or a recurring donation?

If recurring, what would you like the frequency to be?

Gift Allocation

Choose the Service or Services to which you would like to give (Optional)

If you chose "other", please specify.

This gift is made in memory of:

This gift is made in honor of:

Gift designation instructions:

Send acknowledgment of this gift to the following (please include full name and address):

Donation Total

$0.00

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