Point-of-Sale Charity Donation Opt-In Form
Opt in to make a charitable donation as part of your checkout experience.
Would you like to add a donation to your purchase today?
*
Yes, I would like to donate
No, not at this time
Select a donation amount
*
$1
$5
$10
Other amount
If you selected 'Other amount', please enter your donation amount (USD)
Your full name
First Name
Last Name
Email address (for receipt, optional)
example@example.com
Choose the charity to support
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Please Select
Children's Fund
Environmental Trust
Local Community Aid
Other
Would you like to receive updates about our charity efforts?
Yes
No
Comments or dedication (optional)
Complete Donation
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