Setebaid Services, Inc.

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Giving to Setebaid®

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Giving to Setebaid Services® Diabetes Camps

Donation:	Walk Support General Donation Campership Camp Support
Amount of Contribution:	$
Date:
How would you like to pay?	Master Card Visa Discover
Card Number:
Expiration Date (MM/YY):
Security Number: (Note: The Security Number is a three digit number on the back of the credit card, usually in the signature block. If the entire card number is in the signature block, the Security Number will be the last three digits)
Name on Credit Card:
Street Address: (that appears on the credit card statement)
City:
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Zip Code:
Phone:	( ) -
Email Address:	(optional)
Questions or Comments:

By clicking the submit button below, I hereby acknowledge that I am over 18 years of age, the card recorded above is my card, and the information entered above is true and correct. I agree to pay the above amount in accordance with the policies established by the card's plan and I understand that, to comply with IRS regulations, this is a non-refundable contribution.

Setebaid Services,® Inc. is a 501(c)(3) organization as defined by the Internal Revenue Service Code of the United States of America. This contribution may be tax-deductible to the extent permitted by IRS regulations. Please consult with your professional accountant to determine specific deductibility.

The official registration and financial information of Setebaid Services,® Inc. may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.