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:
Credit Card#:  *
Expiration Date:  *
Card Verification Value:   *
E-Mail Address:  *
 

Donation Information

PAYMENTS: to combine, use OTHER and explain Annual Dues and Room Assessment with SAS - $570.00
Annual Dues and Room Assessment with SAS and PHF - $670.00
Lunch Ticket Book of 10 tickets - $170.00
Rotarian of the Day - $100.00
Single lunch ticket - $20.00
Annual dues and Room Assessment July through June - $470.00
Holiday Party - $50.00
Holiday Party for 2 - $100.00
Pollinator Garden Sponsor Sign - $500.00
 Other: 

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