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Please Enter Purpose Of Your Donation
 
Please Enter Your Donation Amount $  
Mailing Information (required)
First Name:    MI:   Last Name:
Home Address: City:
State: Zip:
Home Phone: () - Email:
Billing Information (required)
First Name:   Last Name:  
Street Address:   City:
State/Province:   Zip/Postal Code:  
Phone:
Credit Card (required)
Note: Do not include dashes in Credit Card Number
Credit Card Number:   *
Expiration Date:       
   Sub Total $
Service Fee $
Grand Total $

By completing the on-line registration Card Holder acknowledge receipt of goods and or services in the amount of the total shown and agrees to perform the obligation set forth in the Card Holder's agreement with the issuer of said card. Request for refunds must be sent to the 7th District Keeper Of Records and Seal in writing or via email.

   

11/20/2024 11:57:50 PM
 
Credit Card Processing
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