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First Name

Last Name

Telephone Number

Email Address

Pronouns

Other Pronoun

Street Address

City

State

Postal Code

I would like to make a one-time giftI would like to set up a recurring gift

One Time Gift Information

Amount

Cover the 3% processing fee

on my contribution

Make this donation anonymous

Fund

This gift is

Honoree or Tribute Name(s)

Message for card:

Mail notification to (optional):

Additional information or questions?

Recurring Gift Information

Amount

Cover the 3% processing fee

on my contribution

Frequency

Would you like to end your recurring donation after a specific number of installments?

After this payment, how many more payments would you like to have withdrawn from your account?

Enter a number between 1 and 50 if you would like to end your recurring donation after a specific number of installments.

Fund

This gift is

Honoree or Tribute Name(s)

Message for card:

Mail notification to (optional):

Additional information or questions?

Processing Fee

Payment Method

Credit CardeCheck/ACH

Total (today's payment)

Payment Information

Billing First Name

Billing Last Name

Card Number

Code

Name on Account

Bank Name

Bank Routing Number

Bank Account Number

Account Type

CheckingSavings

Payments

Total Payments

Authnet_Hidden_Fields

Once you submit this form, the recap screen will come up. You must then select confirm at the bottom of the page to process your payment information.

When you confirm you will receive an email receipt showing the payment was complete and your donation was accepted.

info@rodephshalom.org