BJB Safe Haven Donations : Christian Churches United of the Tri-County Area

Donation Amount

Name

First Name *

Last Name *

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Select a Payment Method

Cardholder Name

Credit Card #

Expiration Date

Security Code

Cover the fee associated with this online transaction?

Yes, I will pay an additional {transaction_fee} to cover the cost of this transaction.

Cover the fee associated with this online transaction?

Account Holder

First Name

Last Name

Account Type

Account Number

Routing Number

Make this a recurring payment?

Make this a recurring payment?

Your total payment will be .

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Address

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

special comment

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