Across Nations
Secure Payment Form - One Time Payment
Donation Summary:
Date:
01/17/21
Donation Amount:
Fund Designation (Please list specifics in the comments box.):
AN General Fund
Where Most Needed
New Construction (Radio Building)
Radio General
High Life Youth
Hilltop Christian School (Donations Only)
Community Development
Radio Sharathon
Other (Please Designate in comments)
Comments:
Credit Card Information:
Card Type:
Visa
MasterCard
American Express
Discover
Name as on Card:
Card Number:
Card Expiration Date:
MMYY
Card ID (CVV2/CID) Number:
[
What is the Card ID?
]
Billing Information:
First Name:
Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Country:
Phone Number:
Email Address: