Charlotte Jewish Day School
Secure Donation Form

Please note that BOLDED fields are required
Donation Information:
Order Date: 06/26/17
Amount you would like to donate:
Order Number:  
Customer IP: 54.80.93.234 
Please make a selection from the following:
Do you want this gift to be anonymous: Yes   No
Would you like to make this donation in someone else's name? Yes   No
In Honor of/In Memory of Name
Message (optional):
My Employer will match my donation Yes   No
Employer Name:
Planned Giving: Please send me more info on Planned Giving
           
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
 
[What is the Card ID?]
   
Billing Information:
Company Name:
First Name:
Last Name:
Address:
Address Line 2:
City:
Country:
State:
Zip:
Phone Number:
Email Address for receipt:
     
Mailing Information:
Same as Billing:
Company Name:
First Name:
Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Country:
Phone Number: