Donate- Monthly

US Prayer Center Form – Monthly

$ Donation Amount:

You have chosen to donate $20.00 monthly.

Give monthly on day

Please note: your first gift will be charged immediately. All subsequent gifts will be charged on the day of the month requested.

Designation

Gift Preferences

Call ID

Call Date/Time

Create User

DNIS

Response CProject

UPDATE: If the Donor has no email address, please just record their phone number. Do not enter anything for email!

Personal Info

First Name *

Last Name

Is this donation on behalf of a company?

Company Name

Email Address: *

Comment

Phone:

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

Province *

Zip / Postal Code *

Donation Total: $20.00 Monthly

We are a registered charity in Canada | Business registration number: 10691 8352 RR0001