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Kappa Delta Rho Foundation Donation Form
Donation Information
Amount:
Supporting Brother
$ 50.00
Red Rose Society
$ 100.00
Kimball Society
$ 250.00
Old Painter Hall Society
$ 500.00
Founder's Society
$ 1,000.00
Other
$
*
Designation:
Annual Fund
Other
Other
*
Additional Information
Type of gift:
One-time gift
Recurring gift
Pledge (installments)
Frequency:
Weekly
Monthly
Quarterly
Annually
On:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Starting:
Ending:
Ending:
Corporate:
This donation is on behalf of a company
Anonymous:
I prefer to make this donation anonymously
Comments:
Billing Information
Title:
Mr.
Mrs.
Ms.
Miss
Dr.
Prof.
Father
Rev.
Pastor
Rabbi
Brother
Hon.
Capt.
Major
Cmdr.
Col.
Admiral
General
Lt.
1st Lt.
2nd Lt.
Lt. Cmdr
Lt. Col.
CDR
LTC
Senator
Maj.
Mr. and Mrs.
<
Lt Col
MCPO
CAPT
The Hon.
Col
CSM
Sir
Very Rev.
Maj
First name:
*
Last name:
*
Country:
United States
Canada
*
Address lines:
*
City:
*
State:
<Please Select>
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
CZ
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NL
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
NU
*
ZIP:
*
Phone:
*
Email:
*
Payment Information
Payment Method:
Credit Card
Bill me later
Cardholder's Name:
*
Credit Card Number:
*
Card Type:
Visa
American Express
Discover
Maestro
MasterCard
*
Valid From:
01
02
03
04
05
06
07
08
09
10
11
12
/
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
(Maestro/Switch/Solo only)
Card Expiration:
01
02
03
04
05
06
07
08
09
10
11
12
/
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
*
Issue Number:
(Maestro/Switch/Solo only)
Card Security Code:
*
Note: The Card Security Code is not required for Maestro, Switch and Solo cards.
Matching Gifts
My company will match my gift
Company:
*
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