PRAISE 106.5 Donation Form

ACH On?

NoYes

Call Center On?

NoYes

Show Previous Donor Question?

NoYes

Company Matching On?

NoYes

Share?

NoYes

Amount Field Selector

DefaultMajorBible

USD Campaign Name

USD Campaign ID

USD Campaign Description

USD GAU Id

USD Campaign Receipt Language

CAD Campaign Name

CAD Campaign ID

CAD GAU Id

CAD Campaign Description

CAD Campaign Receipt Language

General Receipt Language

Your Information

First Name

Last Name

Email Address

Phone Number

Country

Mailing Street Address

City

State/Province

Zip/Postal Code

Employer Name

Employer DUNS Number

May we have permission for you to receive communications from PRAISE 106.5

YesNo

May I ask if you've ever given to PRAISE 106.5 before? If yes, thank them for their prior gift!

YesNo

If you prefer to remain anonymous and not receive on-air recognition during an on-air fundraiser, please check this box.

Payment Information

Payment Method

Credit CardBank Account

Only monthly gifts can be deducted directly from a United States or Canadian bank account. Please select select Give Monthly and United States or Canada for Country to use your bank account.

Cannot Be Submitted

Select Monthly Recurrence Date

We currently only setup recurring monthly gifts on the 5th and 20th of the month.

Credit Card Number

Credit Card Type

Expiration Month

Expiration Year

Security Code

Account Type

Routing Number

Account Number

Total to Process Now

I'd like to add 2% to cover the processing fees and make my donation go farther.

Amount $

You are signing up for a recurring gift. This amount will be charged once now, then the charge will recur one month from today and on the same day of every month.

You are signing up for a recurring gift. The charge will happen monthly on the date you selected above.

For Credit or Debit Card payments, this amount will be charged once now, then the charge will recur one month from now and this day every month. For Bank Account payments, you will be charged on the 20th of each month until you tell us otherwise.

Calculated Fields

Stripe Fields

Full Name

Stripe Quantity

Contact Information