logo

Sheltered by Jesus LA

Secure Payment Form

    
Donation Date
Donation Amount
Company Name
First Name
Last Name
Address
Address 2
City
State
Zip
Country
Phone Number
Email Address
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID

Number on back of card

Please fill in this form to have your credit card billed for a recurring donation
Recurring donations
Okay bill your credit card
Donation Amount

Amount you would like to donate each time --example "$20.00

Number of Donations

How many recurring donations you of this amount would you like to do? example "12"

Date of Payments
Schedule Donation
Send Recurring Donation Receipt