Peace Lutheran Church of Flagstaff Arizona INC
Secure Payment Form
Donor Information
First Name
Last Name
Address
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State
Zip Code
Phone Number
Email Addresss
Amount
Date
Donation Amount
Gift Designation or Special Instructions
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Recurring Donation Amount
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Daily
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Total number of recurring billing transactions
Date Payments should begin
Send Recurring Billing Receipts
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Credit Card Information
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Card Expiration Date
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