Together, we create life-changing wishes
for children with critical illnesses

Donation Form

Donor Information
Name:
Phone:
Address:
City:
State:
ZIP:
Contribution Information
▢ Check/Money Order
Amount Enclosed: $
▢ Credit Card (please check card type)
▢ Mastercard®
▢ Visa®
▢ Discover®
▢ American Express®
Credit Card #:
Expiration:
Name:
(as it appears on credit card)
CVV Number:
(3-digit security code on back of card)
Designation
Please mail donations to:
Make-A-Wish® America
1702 E. Highland Ave., Suite 400
Phoenix, AZ 85016