Daughters of Wisdom_CF



Secure Credit Card Donation Form

Please note that fields with an asterisk (*) are required.


*Please use this gift for: 
Other gift designation:   

This gift is   in honor of   in memory of   N/A 
Please provide full name of the person being honored/remembered: (No commas or characters, please)
Please send notification to: (Full Name and Address. No commas or characters, please)

*Title: 
*First Name:  *Last Name: 
*Address 1:  Address 2: 
*City:  *State: 
*Zip Code:  Country: 
*Daytime Phone #:  Evening Phone #: 
Company:  *E-mail: 

Please add me to your mailing list   Yes   No 

*Frequency: 
*Amount:   $  .00 (No commas, spaces or characters, please)

If you choose a monthly frequency, please choose the date you would like for us to charge your account:


*Payment Type:   Credit Card   Check

 
If by Credit Card: If by Check:
*Credit Card Type:
*Credit Card #: *Routing #: Where do I find this?
*Exp. Date: / *Checking Account #: Where do I find this?


After ensuring that all of the information above is correct,
please click the Submit Form Now button ONLY ONCE.
Multiple clicks of the Submit button will result in duplicate charges to your account.
An email confirmation will be sent to the email address you provided.

 

  
Daughters of Wisdom, US Province
385 Ocean Avenue • Islip, New York 11751
Phone: (631) 277-2660 • Fax: (631) 277-3274
Send us an e-mailwww.daughtersofwisdom.org


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