DOOR (Discovering Opportunities for Outreach & Reflection)
Secure Payment Form
Donation/ Payment Summary:
Order Date:
10/30/24
Donation/ Payment Amount:
Customer IP:
18.119.104.101
Donation Designation or Payment Description:
Credit Card Information:
Card Type:
Visa
MasterCard
Discover
Name on Card:
Card Billing Address:
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:
City:
State:
Zip Code:
Country:
Phone Number: