Donate for Stoves Online Payments Donation Amount*[ Please enter amount in US$ ] Donor Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Donor Organization (leave blank if same as above)If this donation is made on behalf of an organization or a third party, please enter their name.Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email (Required)*Acknowledgments are sent by email. Phone (Optional)Payment Options*Please select desired payment option.Credit or Debit CardPayPalElectronic Check (eCheck)CheckOtherCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name If you wish to make a donation using a check, it should be made payable to Juntos Energy Solutions, NFP for the full donation amount and enclosed in an envelope with a separate sheet of paper clearly showing your name and email address. We will use the name and email address you provide to match your payment to the email address you are providing on this form (see email address field above). Envelopes should be addressed to: Juntos Energy Solutions, NFP 227 S. Orr Drive Normal, IL 61761 If mailing a check, please be sure to click the Submit button below to enter your information (as filled out above) into our system. Thank you.If you wish to make a donation using an electronic check (eCheck) or other means of electronic funds transfer (EFT) to our Chase Bank account, we will be happy to contact you and help you set up that transfer. If you wish to arrange a donation using a method not listed above, we will be happy to assist you. You may contact us either by email or phone: Email: email@example.com Telephone (USA Office): 309-452-7072 If you will be contacting us, please be sure to click the Submit button below to enter your information (as filled out above) into our system. Thank you.Please select the best way to contact you:By email, using the email address I've entered above.By phone, using the phone number I've entered above.By mail, using the postal address I've entered above.