Donation Refusal Form
Use this form to record your decision not to make a donation.
Your name
*
First Name
Last Name
Email address
*
example@example.com
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization receiving the donation request
*
Campaign or program
What are you declining?
*
A specific donation request
All future donation requests from this organization
A recurring donation arrangement
Other
Reason for declining
*
Please Select
I do not wish to donate at this time
I have already made my giving decisions
I do not wish to receive donation requests
Other
Effective date of refusal
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you like the organization to handle future donation-related contact?
*
Do not send me future donation requests
Contact me only about this specific request
No change to other communications
Additional details
Submit Refusal
Should be Empty: