OUR Place - Credit Card 

Thank you for your donation to the 2020 OUR Place Employee Giving Effort!

Please complete the form below to make a gift by credit card. A minimum gift of $5 is required to receive an OUR Place t-shirt. Gifts under $5 will receive a tote bag.

Please contact Kate Leahy, Annual Giving Manager, with any questions or issues.

Donation Information
Amount:	Gift $ 1,000.00 Gift $ 500.00 Gift $ 250.00 Gift $ 100.00 Gift $ 50.00 Other $     *
Designation:	Greatest Need Education Patient Care Research
Additional Information
Tribute information for Memorial Gifts is available at the bottom of the page
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
Donation Type:	Credit Card (emp)
Department/Unit:		*
Manager Name; Director Name:		*
T-shirt/ Tote:	<Please select> No T-shirt or Tote Tote Bag Small Medium Large Extra Large 2XL 3XL 4XL	*
Billing Information
Title:	<Please select> Captain Chaplain Chief Colonel Commander Corporal Dr. Father Governor Lieutenant Major Miss Mr. Mrs. Ms. Officer Pastor Rabbi RADM Reverend Sergeant The Honorable	*
First name:		*
Middle name:
Last name:		*
Country:	United States Australia Bahamas Canada China France Ireland Israel New Zealand South Africa Sweden The Netherlands United Kingdom	*
Address lines:		*
City:		*
State:	<Please Select> AE AL AA AK AB AS AP AZ AR Ber BC CA CZ Cap Cha CO CT DE DC FM FL GA GU HI Hop ID IL IN IA KS KY LA ME MB MH MD MA Med MI MN MS MO MT NE NV NB NH NJ NM NY NL NC ND MP NT NS NU OH OK ON OR PW PA PE PR QC RI SK SC SD Sou TN TX Uni UT VT VI VA WA WV WI WY YT	*
ZIP:		*
Phone:
Email:		*
Confirm Email:		*
Payment Information
Payment Method:	Credit CardDirect Debit
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  (Maestro/Switch/Solo only)
Card Expiration:	01 02 03 04 05 06 07 08 09 10 11 12  / 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040	*
Issue Number:	(Maestro/Switch/Solo only)
Card Security Code:		*
	Note: The Card Security Code is not required for Maestro, Switch and Solo cards.
Tribute Information
Type:	In Honor Of In Memory Of	*
Name:		*
First name:
Last name:		*
	Please inform the family of my tribute	*