Gift & Payment Information
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Gift Information

Field Is Required Select A Gift Amount:

  Company Matching Gift Information

  Many companies offer employees a matching gift benefit that increases your gift
  to Komen Connecticut. If your company has a Matching Gift Program, please fill
  out the proper matching gift form (either electronically or hard copy) and send it
  to the Komen Connecticut office to be completed.

         Please mail matching gift forms to:

         Connecticut Affiliate of Susan G. Komen for the Cure
         74 Batterson Park Road
         Farmington, CT 06032

Honoree Information

  Optional Tribute Card

  Komen Connecticut sends a tribute card or letter acknowledging your donation to
  a family member for an "in memory" donation, or the honoree themselves for an

  "in honor" donation. To customize a tribute card, complete the information below.

Billing Information

Credit/Debit Card Information

Credit Card Information:

Credit Card Type:
  • Visa
  • Discover
  • American Express
  • MasterCard
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