SAS Recurring Contribution
Thank you for donating to SAS. Your contribution is appreciated!


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Donation Amount:
(Billing occurs monthly)		 $25.00     $50.00     $75.00    
Other:  $
   
Number of Monthly Payments:
(*=indefinite)
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Address:
Card Billing Zipcode:
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:
Additional Information:
School Affiliation:
Email Address: