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)

Card Type

Cardholder's First Name

Cardholder's Last Name

Credit Card Number

Exp Date
(e.g.: 05/2023)
Security Code

Cardholder's Billing Street Address

Billing City

Billing State
(2-digit state code)
Billing Zip Code

Billing Country
(2-digit country code)