Levy Church of Christ
Secure Payment Form - One-time Payment

 
Payment Summary:
Payment Date: 12/21/24
One-time Payment Amount:
Designation:
Description:
           
Credit Card Information:
Card Type:

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:
Phone Number:
Email Address: