First Namerequired

Last Namerequired

Gift Amountrequired

Would you like to cover the additional credit card processing fees?

Yes No

Additional Amount for Fees (3-5%)

Total Amount to be Charged to Card*

*HCDS cannot accept American Express at this time.

Billing Address

Address 1

Address 2

City

State

Zip Code

Phone Typerequired

Phone Numberrequired

Affilliation

Student/Alum Name:

Name as I (we) wish to be listed in the annual report:

I (we) would like this donation to support the following area(s):

I am interested in making recurrent donations (ie. quarterly, monthly, etc.). Please contact me to set this up.

Yes No

Company Match

My company will match my gift

Please note: Online gifts made via credit card are subject to a processing fee imposed by credit card companies of between three and five percent of the donation amount; this fee is charged to Harbor. In other words, your net gift is less than the amount you are contributing. To help ease the financial burden on Harbor, we would be so grateful if you would consider adding a small amount to your gift to help Harbor defer the cost of these fees. The full amount of your gift, including this additional amount, will be considered a donation to Harbor Country Day.

Please forward company matching form to the business office at the following address:

Harbor Country Day School
Business Office
17 Three Sisters Road
St. James, NY 11780

or email to:

Diane Abrams
dabrams@hcdsny.org

A Note from Alumni and Friends!

Billing Address

Harbor Country Day SchoolBusiness Office17 Three Sisters RoadSt. James, NY 11780

Diane Abramsdabrams@hcdsny.org

Harbor Country Day School
Business Office
17 Three Sisters Road
St. James, NY 11780

Diane Abrams
dabrams@hcdsny.org