General Donation & Payment Form


Welcome to the Children of All Nations payment processing form. This form allows for simple transactions via credit card/debit card via our secure site to make donations to our charitable programs and for families contracted with our agency to conveniently make payments for contracted services. This form accepts Visa, Mastercard, and Discover. If you have any questions regarding payments you are making, please contact our business office during regular business hours at 512-323-9595.
 

Adoption fees and services:
Total Amount: $
For all above selections
General Donation:
Donation For:
Donation Amount:
 If you selected other, please specify the amount below.
Other Donation Amount: $
 minimum donation of $25
In Honor of:
  Send donation letter for tax purposes
*Your Full Name:
*Address:
Your Phone Number:
*E-Mail Address:

 

Billing Information

*Driver License #:
*Driver License State:
*Name as shown on your card:
*Select the card you are using:
*Card Number: - - -
*Expiration Date:  
*Credit Card Validation       Number (CCV):
*Billing Street:
*Billing City:
*Billing State:
*Billing Zip Code:
*Billing Phone Number: - -

By signing my name below I agree that any adoption fee(s) paid to Children of All Nations, as indicated above, is nonrefundable. I verify that by signing the above credit card authorization form, I choose to pay by credit card for all services listed above and agree to all terms and conditions stated within the accompanying signed Agreement(s) or form(s). I acknowledge and understand, should I choose to stop my adoption at anytime during the process, all fees rendered on the above form are non-refundable.

Total Amount Charged to Card: $
*Cardholder's Signature:
Type the characters you see in the picture:

* denotes required field