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:

Credit Card#:

Expiration Date:

Card Verification Value:

E-Mail Address:

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Donation Information

I would like to make a donation of:

Amount - $1,000.00
Amount - $500.00
Amount - $250.00
Amount - $100.00
Amount - $50.00
Amount - $25.00
Other:

Recurring:

Make this a one-time donation
Make this a recurring donation.

Options:

I would like my gift to remain anonymous

Tribute Type:

Please send an acknowledgement email to


First:
MI:
Last
Email:

Please send an acknowledgement letter to


First:
MI:
Last
Address:
City:
State
Zip

Additional comments or suggestions
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This transaction is being processed by Franciscan Ministries Inc using Secure Socket Layer (SSL) Encryption.