Thank you for supporting our mission of providing quality healthcare & housing for seniors. With your help, we can continue our decades-long commitment to seniors, their families, and our communities.
Comments:
Let us know how you’d like your donation used
:
Account Holder Information:
First Name:
Last Name:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
District of Columbia
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
Virgin Islands
Armed Forces Africa
Armed Forces Americas
Armed Forces Canada
Armed Forces Europe
Armed Forces Middle East
Armed Forces Pacific
Zip:
Email for receipt:
Amount (format 0.00):
Payment Type:
Credit/Debit Card
Electronic Check
Card Type:
Visa
Mastercard
Discover
American Express
Credit Card Number:
Credit Card Expiration:
January
February
March
April
May
June
July
August
September
October
November
December
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
Credit Card CVC:
Bank Account Type:
Checking
Savings
Bank Routing Number:
Bank Account Number:
Usio, Inc. processes ACH transactions on behalf of Holton Manor. By clicking ‘Submit’ below you agree to pay via this ACH Authorization. You acknowledge that you are voluntarily choosing to pay electronically. You understand and acknowledge that you may terminate the ACH Authorization by notifying us at support@usio.com, subject: ACH Authorization Disputes, and in such time and manner as to afford us and your bank a reasonable opportunity to act on it.
Refunds are handled on a case by case basis
Privacy Policy