Roman Catholic Diocese of Lafayette (Louisiana)

Parish Affiliation

Select which church parish you attend from the drop-down menu below.

Affiliated Church Parish: *

Donor Information

First Name: *

Last Name: *

Billing Address: *

The address that appears on your credit card statement.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Preferred Telephone: *

Preferred E-mail: *

A receipt will be e-mailed to this address.

Donor Record No.:

Your donor record number is located on the pledge slip included with your letter.

Prayer Intentions:

Your Payment Information

Name on Card:

Card Number:

Card Security Code:

Expiration Date: