Recurring Payment
If you would like to enjoy the convenience of automatic recurring payments, simply complete and sign the form.
Doner Information:
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Which fund do you wish to donate to?
"X Vision" (Dining Hall)
XYZ's Club
Gideon Club
General Fund
Wish List
Other
Select Donation
prev
next
( X )
Donate Yearly
USD
for each
year
Â
Â
Donate Monthly
USD
for each
month
Â
Â
In memory or support of:
First Name
Last Name
Start Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
1
End Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
2
Sign Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Donor Signature
Submit
Should be Empty: