Customer IP: 18.119.104.101 
DOOR (Discovering Opportunities for Outreach & Reflection)
Secure Payment Form

 
Donation/ Payment Summary:
Order Date: 10/30/24
Donation/ Payment Amount:
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Credit Card Information:
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Name on Card:
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Card Billing Zip Code:
Card Number:
Card Expiration Date: MMYY (do not use '/')
Card ID (CVV2/CID) Number:
 [What is the Card ID?]
Email Address: (REQUIRED for all transactions)
   
Additional Contact Information:
First Name:
Last Name:
Preferred Mailing Address:
Address Line 2:
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