English District of The Lutheran Church--Missouri Synod
Secure Payment Form
Summary
Date
Amount
$25
$50
$100
$500
Other, Max. $2500 per transx
Description
General Missions, A Dollar for Missions (1-1-1), Endowment Fund, Other (please specify)
Donation Frequency, if recurring
Save Customer Information
No
Yes
Enable Recurring
No
Yes
Total Number of Transactions of Recurring Billing
Frequency of Recurring Donation
Disabled
Daily
Weekly
Biweekly
Monthly
Bimonthly
Quarterly
Biannually
Annually
Date of first transaction is TODAY. Date of Next Recurring Donation
Credit Card Information
Pay By Check
Name as on Card
Card Billing Address, City, State/Province
Card Billing Zip/Area Code
Card Number
Card Expiration Date
CVV2/CID
Pay by Check - Single transaction limit of $2,500.00
Pay By Credit Card
Bank Routing Number
Bank Account Number
Bank Account Type
Checking
Savings
Donor Information
First Name
Last Name
Address
Address 2
City
State/Province
Zip/Area Code
Country
Phone Number
Email Address
Submit
