Greek Orthodox Church of Greater Salt Lake

Secure Donation Form

One Time Donation

Type of Donation:

Donation Amount:

Donation In Memory Of:

Description:

Notes:

Recurring Donation

Recurring Donation:

Recurring Amount: (Also put this amount in Donation Amount in left column)

Schedule:

Start Date:

Number of Payments:

Credit Card Information

Name as on Card:

Card Billing Address:

Card Billing Zip:

Card Number:

Card Expiration Date:

Card CVV2/CID:[?]

Billing Information

Company Name:

First Name:

Last Name:

Address:

Address Line 2:

City:

State:

Zip:

Country:

Phone Number:

Email: