International Veterinary Information Service

Optional Donation Information:

Donor Name:

Indicate here how you would like to be recognized (your name, name of your clinic or company, dedicated to ...etc. - if different from name above).

Invoice Address:

If you are a company, corporation or institution and need to be invoiced for this donation, please indicate here the full name and address for the invoice.

Anonymous Gift:

Check here if you would like your gift to be anonymous.

Message or Testimonial to IVIS:

I give permission to use my Message/Testimonial.

Payer Information:

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Your Payment Information:

Name on Card:

Card Number:

Card Security Code:

Expiration Date: