Hearts Remembered - West Texas Rehab

Hearts will be displayed at West Texas Rehab during the month of February.
All donations are tax deductible and will benefit terminally ill patients and their families in Abilene and 11 surrounding counties.

Donation Amount

One heart represents one loved one.

Custom Donation Amount

Minimum Price: $10.00

Cover Transaction Fee

I would like to cover the Stripe transaction fee of 2.9% + $0.30 for my donation.

Cover Transaction Fees

You're covering: $0.00 in Stripe transaction fees.

Name

First

Last

Phone

Email

Mobile Marketing Consent

I consent to receive marketing emails from West Texas Rebab at the email address I provided.

Address

Address Line 1

City

State

Zip Code

Name(s) of those I wish to honor with my 1 ♥ purchase:

Name(s) of those I wish to honor with my 2 ♥'s purchased:

Name(s) of those I wish to honor with my 6 ♥'s purchased:

Name(s) of those I wish to honor with my 15 ♥'s purchased:

Name(s) of those I wish to honor with my custom donation:

Donation Summary (with Stripe fees covered)

Item Quantity Qty Total

There are no products selected.

Donation Amount - $10 (1 ♥) 1 $10.00

Donation Amount - $20 (2 ♥'s) 1 $20.00

Donation Amount - $50 (6 ♥'s) 1 $50.00

Donation Amount - $100 (15 ♥'s) 1 $100.00

Donation Amount - Custom Donation (♥'s) 1 $0.00

Custom Donation Amount 1 $10.00

1 $0.00

Total $10.00

of fees Phone

Donation Summary