Payment Processing - Cardholder Information

Secure Donation Form

To process your donation using Visa, MasterCard, American Express, or Discover, please fill in the secure order form below with the requested information exactly as it appears on your monthly bankcard statement.

Billing Information - Exactly as it appears on your Credit Card

Donor Prefix:

Donor First Name:

Donor Middle Initial:

Donor Last Name:

Suffix (eg: Jr,Sr,II):

Billing Address:

Apartment or Suite:

Billing City:

Billing State or Province:

Billing Postal/Zip Code:

Billing Country:

Day Time Phone Number:

Mobile Phone Number:

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Expiration Date:

Card Verification Value:

E-Mail Address:

Donation Information

Rotary Club of Rochester Foundation

Donation - $40.00
Donation - $5,000.00
Donation - $2,500.00
Donation - $1,000.00
Donation - $750.00
Donation - $500.00
Donation - $300.00
Donation - $200.00
Donation - $50.00
3 Club Website Advertising - $199.00
3 Club and TRCR Advertising - $499.00
10 Tree Whips - $10.00
Other:

Rotary Fund

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This transaction is being processed by The Rotary Club of Rochester Foundation using Secure Socket Layer (SSL) Encryption.