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

I would like to: Make a donation of - $100.00
Make a donation of - $250.00
Make a donation of - $500.00
Make a donation of - $1,000.00
Sponsor a Back To School Student - $50.00
 Other: 
Recurring: Make this a one-time donation
Make this a recurring donation.
Gift Designation:
Options: Make this donation anonymously?
Tribute Type:
Enter Home Church - Christmas - Birthday Requests
   Maximum of 210 Characters
Characters not allowed: %, &, #, <,>
 
* = Required Field


This transaction is being processed by Christian Community Service Center, Inc. using Secure Socket Layer (SSL) Encryption.