OREF Pledge Payment Form

Gift & Payment Information

Review Gift

Pledge Payment for: (indicate appeal or campaign)

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This amount will be applied to your existing pledge balance.

If you would like to have your pledge payment made automatically, please select Recurring payment below and then choose a payment duration.

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Total Payment: 0.00

Billing Information

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First Name:

Middle Name:

Last Name:

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Street 1:

Street 2:

City:

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ZIP/Postal Code:

Country:

Email Address:

Yes, I would like to receive communication from this organization.

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Payment Information

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Credit CardChecking Account

Credit Card Information:

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Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Checking Account Information:

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Bank Account Number:

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Account Type:

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By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.

Billing Information

Payment Information

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Credit Card Information:

Checking Account Information:

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