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Remit By Credit Card

Remit By Credit Card


Remit By Credit Card

An asterisk * indicates a required field

1. Billing Information

First Name* Last Name*

Address* (Credit Card Billing Address)

City* State* Zip*

Phone*

Email*

2. Method

cards4.gif

Credit Card Number* Expires*
(mm/yy)

CVV*

3. Amount*
$

4. Recurring Payment Option (optional)
If you elect this option, the amount you indicate will automatically be charged to your credit card at the beginning of each month for the duration you choose.

Would you like this payment to be monthly? Yes No

First Month Year
Last Month Year

5. Payment information (optional)
Please indicate what this payment is for (e.g. Passover donation, mark a special occasion, tribute, tuition etc.)

6. Notification information (optional)
If you would like us to send others notification of your gift (without the gift amount), please provide mailing addresses and how you would like your name to appear.

7. Make Payment
Please review all of your entries carefully. Then, click the 'Submit' button one time.

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