Dominican Retreat & Conference Center Secure Contribution Form

Secure Server Donation Form

Please note that fields with an asterisk (*) are required.
You can use a Visa, Mastercard and Discover with this form.

*First Name:   *Last Name:  
*Street or PO Box:   Apt./Suite Number:   
*City:    *State:   
*Zip Code:    *Country:   
*E-Mail:   *Phone:  

Use our giving table below as a guide for either your One-Time or Monthly Gift
$5 ∼ $59 Friend $60 ∼ $119 Patron
$120 ∼ $499 Sponsor $500 ∼ $999 Supporter

Using our Giving Levels table, please enter your contribution amount.

*Use my gift for:    
*Contribution Amount $:    
*Contribution Frequency:    



*Payment Type:    Credit Card   Check (Electronic Funds Transfer) 

If by Credit Card:  
*Credit Card Type:  
*Credit Card Number:  
*Exp. Date:   /

If by Check:  
*Routing Number:   Where do I find this?
*Checking Account Number:   Where do I find this?

If you have made a memorial/honorary gift, please provide the information below:
(No commas or characters, please)
This gift is in memory of:  
This gift is in honor of:  
Address:  
City:   State: Zip Code:

I wish to know how to include the Dominican Retreat/Conference Center in my estate plans.  Yes   No 
I want to remain anonymous.  Yes   No 


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.

 

  
Dominican Retreat & Conference Center
1945 Union Street
Niskayuna, NY 12309
Phone:518-393-4169 / Fax:518-393-4525
E-Mail:dslcny@nybiz.rr.com


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