Hope du Jour Donation : HopeDuJourDonation : Crisis Control Ministry

Thank you for participating in Crisis Control Ministry's 2024 Hope du Jour. Use this form to remit your tax-deductible donation.

Donation Amount (10% of May 7, 2024 Sales) (Required)

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Name of Establishment (Required)

Establishment's Physical Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Mailing Address (if different from location address)

Country

Address Line 1

City

State/Province

Postal Code

Your Name

First Name *

Last Name *

Title (Required)

Phone Number (Required)

Your Phone Number

Email (Required)

Your Email

Name of Preferred Contact Person

First Name *

Last Name *

Preferred Contact Title (Required)

Preferred Contact Phone Number or Email Address (Required)

Feedback and Comments

Cardholder Name (Required)

Credit Card # (Required)

Visa MasterCard American Express Discover

Expiration Date (Required)

Security Code (Required)

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

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?

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged