Iowa District West LCMS
Secure Payment Form
Summary
Date
Amount
Designation
Select One
General
Church Worker Debt Reduction
Disaster Relief
IOWAY
Ankeny The Gate
Council Bluffs St. Paul
Hispanic Ministry Siouxland
Hispanic Ministry West Des Moines
Student Financial Aid
Youth Gathering
Comments
Credit Card Information
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
Donor Information
Church Name
First Name
Last Name
Address
City
State
Zip
Phone Number
Email Address
Submit
