Rocky's Agency On Aging Donation Page

Rocky's Agency on Aging, a free one-stop shop to find community resources, connects seniors and persons with disabilities to information and services. Programs include Information, Assistance and Referral, Medicare Information/Counseling, Long-Term Care Ombudsman Advocacy, Options Counseling, and Senior Medicare Patrol. Service area includes Broadwater, Gallatin, Jefferson, Lewis & Clark, Meagher, and Park counties. Area IV Agency on Aging provides services to seniors over age 60 and adults age 18 and older with a disability.

Your contribution will improve the quality of life and promote self-sufficiency of seniors and people with disabilities by connecting them with the vital community resources available to them.

Thank you in advance for your generosity.

Donation Amount

1. $100
2. $50
3. $25
4. $10
5. Other

If "Other" please use "Other Amount" field.

Other Amount

$

First Name

Last Name

Email

Mailing Address

City

State

Zip Code

p8ufjt1tj8ep

Credit Card Information

Cardholder Name

Credit Card #

Visa MasterCard American Express Discover

Expiration Date

Security Code

Billing Zip Code

Make this a monthly payment?

1. Yes, charge me today and on the 21st of every following month.

Make this a monthly payment?

Cover the fee associated with this online transaction?

1. Yes, I will pay an additional {transaction_fee} to cover the cost of this transaction.

Cover the fee associated with this online transaction?

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Comments

We would like to celebrate you as one of our donors. Can we use your name, donation amount, and comments for publications? This could include for our website, social media, and print publications.

1. YES!
2. No, I would like to remain anonymous.