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

Amount Diamond - $10,000.00
Gold Sponsor - $5,000.00
Silver Spnsor - $2,500.00
 Other: 
Recurring: Make this a one-time donation
Make this a recurring donation.
Options: I prefer to make this donation anonymously
 
* = Required Field

This transaction is being processed by Help the Children of St. Michel de LAttalaye HA IN using Secure Socket Layer (SSL) Encryption.