Credit Card Payment

Please use this form if you wish to make a donation or pay an invoice via credit card. 
Transactions will be processed within 24 hours. 

Contact - First Name:
Contact - Last Name:
Contact - Email:
Confirm Email:
Contact - Phone:
Reason for Payment:
Card Holder Name:
Credit Card Number:
Expiry Date:
Card Type:
Card CVV Code:

Payment Amount:

Enter the Security Code:
I agree to the terms and conditions:
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