Bless Our Children
Secure Credit Card Donation Form


We would like to thank you for using the Bless Our Children Secure Donation Form.
We have taken great care to ensure that your transaction is safe and secure.

NOTE: All fields are REQUIRED.
Please fill out ALL of the fields below to ensure that your donation will be processed correctly.

Enter your total WITHOUT the dollar sign ($).
For example, if your total donation is $150.00, just enter 150.00
Enter Total Donation Below To Be Charged To Card.

Card Type:

Credit Card Number:

Expiration Date (Month/Year):
/

Card Security Code(CVV):

What and where is my CVV CODE?

This Donation Is To Be Used For:

Email Address:

Phone Number:

Name:(As it appears on your card)

Address:

City:

State:

Zip code:

In the box below please place any comments
OR
include the "Challenge Name" to be recognized on-air.

NOTE: Please only click the
"Continue and Submit Payment" button ONE TIME.