Credit Card Donation Form

Our Lady of Grace School
Credit Card Donation Form
Your credit card information is encrypted and secure. Partners in Mission shares no donor information
*required

Donation
Amount*		$1,000$500$300 $200 $100 Specify an Amount - $

Donation Frequency		One Time Payment
		Monthly Reoccuring Payment

Contact Information
First Name*
Last Name*
Company/Organization
Address*
City*
State*
Zip Code*
Email Address*
Phone

Donation Total $

Credit / Debit Card Information(all fields required)
Cardholder's First Name *

Cardholder's Last Name *

Cardholder's Billing Street Address *

Billing City *

Billing State *
(2-character state code)
Billing Zip Code *

Billing Country *
(2-character country code)
Card Type *

Credit Card Number *

Exp Date *
(e.g.: 05/2024)
Security Code *