Investment Amount*

Do not use $ or , (Correct Style: 1000.00)
$

Investment Designation*

---Make Selection--- College Scholarships Seminary Scholarships
Or
Enter an Alternative Designation

Investment Notes

Personal Information

Name:

E-Mail Address:

Address:

City:

State or Province:

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Postal Code: (If outside the US, enter 00000)

Phone Number:

Required Format: 1-123-456-7890

Cell Phone Number:

Required Format: 1-123-456-7890

Card Information

Name (as it appears on card):

Billing Address:

Important: This information MUST match the information on your Credit Card billing statement.

Card Type:

Visa Master Card Discover

Card Number:

Expiration Date:

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