Online Dedication Form

Please fill out the form a click the "Submit" button at the bottom. This will send your request to us.

I would like to dedicate my donation:

Full Name

Ocasion

I would like Gleaners Dispatch, Inc.
to send an appropriate acknowledgement of my Donation Gift to:
Yes No

Full Name

Street Address

City

State

Zipcode

Telephone (optional)

Donation To Gleaners Dispatch, Inc. Is Being Made By:

Full Name

Street Address

City

State

Zipcode

Telephone (optional)

My GIFT of $
($50, $100, $250, $500, $1,000, $5,000, 10,000, etc.)

Is Being Paid in the Following Way:

Credit Card at gleanersdispatch.org/donation
or
Check or Money Order Payable to Gleaners Dispatch, Inc. and mailed to:

GLEANERS DISPATCH, INC.
8207 103rd Street
Jacksonville, FL 32210-6553
(904) 777-6344

Gleaners Dispatch, Inc. is an IRC 501c3 nonprofit charitable organization. You will be sent a Year-End Contribution Receipt.