Donor

Taxpayer Name

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First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Note to First Time Donors:
The Iowa Department of Revenue requires a SSN or FEIN in order to issue an Iowa

Tax Credit Certificate. Please contact Our Faith STO Director, Steve Kane at (563)552-0297 with this information.

If Donation by a Business, Please List Corporation Type (Ex: LLC, C Corp, etc.) Please enter valid data.

If Donation by a Business, Please List Tax Year End Date

mm/dd

Please enter a date.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter valid data.

Donation Amount REQUIRED Please fill out this field. Please enter an integer (number).

Gift Designation REQUIRED I hereby direct 100% of this contribution be deposited in the STO’s unrestricted fund. I hereby direct 50% of this contribution to provide tuition assistance to students attending school(s)/system(s) listed below. Please fill out this field.