Emmanuel College Payment Form

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Donation Information

Donor Name*

Address*

Address Line 2

City*

State*

Zip*

Personal Email*

Gift To

Donation Item 1

Additional Gift To

Donation Item 2

Additional Gift To

Donation Item 3

Additional Gift To

Donation Item 4

Endowed Gift To

Donation Item 5

Total Amount of Payment

Special Request or Instructions

Payment Information

Card Holder Name*Full name as displayed on card

Card Type*

VISA

Mastercard

American Express

Discover

Card Number*

Expiration*

CVV*

Card Holder Address*

Address Line 2

City*

State*

Zip*

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