Support HA

* First Name:  * Last Name: 
Second First Name:  Second Last Name: 
* Phone:  *Email: 
* Address:  * City: 
* State & Zip:   Country: 

Affiliation: 
Please designate my gift to the: 
If other, please specify

Name(s) as you wish to be recognized:
In Honor Of:
In Memory Of:
  I wish to remain anonymous
  My employer will match my annual giving contribution
Submit your employer's matching gift form to the Development Office.

Your first payment will be charged/debited today, and future payments will be charged/debited mid-month. The transaction will be conducted immediately and will appear on your credit card statement in the name of Houston Academy School. For your security, we have ensured that the forms meet all of the Payment Card Industry Data Security Standards (PCI-DSS).
* Gift Type
One Time Gift
 
*Gift Amount:
Recurring Gift
 
Monthly Payment
Total pledge amount should be paid between today and June 30.
* Installment Amount/Monthly Payment:
* Number of Payments:
* Total Gift:


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