COVID-19 Relief Pledge Form (Check or ACH)

The JCCC Foundation (FIN#36-3738061) is a 501(c)(3) organization. All contributions are tax-deductible to the extent permitted by law.

1. Type of Donors*
- Company, Organization, or Group
- Individual
Donor's Name (Company Name)*
Donor's Name (Individual Name)*
Prefix First Last
2. Contact Name*
Prefix First Last
3. Address*
Street Address Address Line 2 City State / Province Zip / Postal Code
4. Phone Number and Ext. (直通電話)*
5. Email*
6. Would you like to receive a receipt for the donation?*
- Yes
- No
7. Enter your donation amount:*
8. Note
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