C89.5 FM - Acceptiva

CHOOSE YOUR OWN DONATION LEVEL (One-Time or Monthly)

Description

Amount

Total

One-Time Donation

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(minimum $10)

Description

Amount

Total

Monthly Donation

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(minimum $5)
We’ll charge your card this amount on a monthly basis.

Choose A Frequency

Recurring Frequency:

Total: $0.00

If you would like a thank you gift, please select from the following:

Donor Information

First Name: *

Last Name: *

Billing Address: *

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

Apartment or Suite #:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone: *

E-mail: *

We do not sell or rent your email address to anyone.

Additional Information

Are you a first time donor?

Yes

Can we thank you on the air?

Yes!

Special Instructions or Comments:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *