Credit Card Payment Authorization Form

HSA-UWC Credit Card Payment Authorization Form

Purpose*

Donor's Name*

Spouse's Name (optional)

Amount*

$

Total

$0.00

Billing Information

Name*

Payment Method

Credit Card
ACH

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

Email*

Confirm Email*

Phone Number*

Yes, it's okay to communicate with me by text message. Message frequency varies. Message and data rates may apply.View our terms of service & privacy policy.

GivingFuel Fundraising Software

Fundraising Software by GivingFuel