Nickname
*
Please Wait...
Thanks for deciding to support our project.
Donation Amount
I would like to make this a pledge
I wish to donate
$25
$40
$50
$100
$200
Other
Or enter amount
*
NZD
I would like to pay $
to cover the processing fee
Donation Frequency
One-Off
Next
Personal Information
Title
First Name
*
Last Name
*
Organisation
Pay on behalf of this Organisation
Email
*
Mobile
Phone
*
Date of Birth
Suburb
City
Country
Country
Search for your address
Search for your address
*
Search for your address
Enter Address Manually
Address
Address 2
Address 3
Suburb
City
Post Code
State/Region
Region
Comments
Select your local branch
National Office
Auckland
Bay of Plenty
Blenheim
Canterbury & West Coast
Canterbury West Coast
Manawatu
Nelson
North Taranaki
Northland
Otago
South & Central Taranaki
South Canterbury
Southland
Tairāwhiti & Hawkes Bay
Waikato
Wairarapa
Waitaki
Wellington
Whanganui
What prompted you to donate today?
*
Appeal letter in the post
Email from CCS Disability Action
Facebook
Website
Word of mouth
Other
Back
Next
Payment Method
Total Donation:
$0
Pay using
Pay using
Please click to accept our terms and conditions
Account Holder
*
Account Number
*
Signature
*
Clear
Credit or Debit Card Number
*
Expiry Date
*
CVC
*
Bank Account
*
Denotes mandatory field
Please click to accept our terms and conditions
*
Tracking General donations
Back
Submit
Powered by vega.works
Just a few last questions
Yes
No
Yes
No
Yes
No
First name
Last name
Email
Thank you we will be in touch shortly