TREHAB A Community Action Agency
DONATION FORM

PO Box 366
Phone: (570) 278-3338
Fax: (570) 278-1889
Email: info@trehab.org

Thank you for your interest in TREHAB A Community Action Agency. Please fill in the fields below, then press "Submit My Donation."

This gift is from:

661-555-5555

Donation Types

  1. Transportation Certificates - Select this option to purchase Transportation Gift Certificates. Please note that this purchase will help someone utilize this valuable service, but is not tax deductible. To give the certificate to a particular person, put his or her name in the "In Memory/Honor of" space below.
  2. D&A Programs - Funds donated under this category will be designated for Trehab's Drug and Alcohol Outpatient Treatment or Prevention departments.
  3. Undesignated - These funds will be used at the discretion of Trehab administration where need is greatest.
  4. Feed A Friend 2016 - Select this option to designate a gift to the 2016 Feed A Friend program.
  5. Fuel Assistance - These funds will be used to provide fuel assistance to low-income residents and families during the cold winter months.
  6. Rental Assistance - With the current housing crisis, Trehab receives many requests for rental assistance from families otherwise unable to afford elevated rental rates. These funds will be used to provide security deposits and one month rental payments.
  7. Food Bank - These funds will be used for one of Trehab's three food banks.
  8. Housing Development - These funds will be used for Trehab's work of providing affordable, pleasant housing for low-to-mid income residents.
  9. Workforce - Donations will go to our Workforce Development programs.
  10. Virginia Grace Productions - Select this option if you are donating to the film project through Virginia Grace Productions.

Please notify the following person that this gift has been made to TREHAB A Community Action Agency

661-555-5555

Please check that all parts of the form above have been completed and then press "Submit My Donation" only once. The confirmation page will appear shortly afterwards. Then you will be able to proceed through paypal paying via Credit Card or Paypal account (not required for payment) to complete the process.

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