Donate to protect children in South Sudan

Your details

Title

First Name

Surname

Phone Number

Mobile Number

We’d love to contact you about all things Fields of Life. This includes our monthly Stories of Hope from East Africa, campaigns, updates and fundraising opportunities. You can unsubscribe at any time.

Yes - Fields of Life can email me

Your Address

House name, no. and street

Town

County

Postal Code

Country

Please do not send me post

Leave a Message

Feel free to leave a message for our Fundraising Team if there is anything you would like us to know about your donation:

Donate Now

Please confirm as applicable:

This donation is my own money or money that I raised, and is not paid for by my company or any other organisation on my behalf.

This donation is not made as part of a sweepstake, raffle or lottery, or raised in exchange for anything in return.

Card Number

Name on Card

Expiry Month

Expiry Year

CVC

Values for Salesforce

Set default values for these fields to define what is passed into Salesforce.

Region

Currency

Fund

Campaign Source (Salesforce ID)

Donation Source Channel

Credit Card Processor

Calculated Fields

These values are calculated in the form, and used in the Salesforce and Stripe connectors

Donation Amount

Single Donation Amount

Eligible for Tax Relief

Stripe

These values are passed back from the Stripe connector after a single one-off donation is charged to credit card.

We promise to never pass your details on to another organisation for marketing purposes. We will store your personal data securely in line with current data protection legislation. If you want to find out more, take a look at our full privacy policy.

Donate to protect children in South Sudan

I would like to donate......

Your details