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English District of The Lutheran Church--Missouri Synod

Secure Online Payment Form

     
Date
Amount
Description

General Missions, A Dollar for Missions (1-1-1), Endowment Fund, Other (please specify)

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Total transactions of recurring billing
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Start Date (for recurring)
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Amount of one-time donation or amount of recurring payment

Church Name
First Name
Last Name
Address
City
State
Zip
Phone Number
Email Address
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Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
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Bank Account Number
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