OUR Place - Credit Card

Please complete the form below to make a gift by credit or debit card. A minimum gift of $10 is required to receive an OUR Place t-shirt.

Once you click submit, you should get a confirmation email. If you do not, please try submitting the form again. If you continue to have difficulty, please contact the Philanthropy Department at 207-662-2669.

Donation Information

Amount:

Gift

$ 1,000.00

Gift

$ 500.00

Gift

$ 250.00

Gift

$ 100.00

Gift

$ 50.00

Gift (min. required to receive t-shirt)

$ 10.00

Other

Designation:

Additional Information

Your t-shirt will be delivered to you within 7 business days. In order to do so, you must provide detailed information about your office location.

Donation Type:

Physical Work Location address,building,floor etc.:

T-shirt:

Billing Information

Title:

First name:

Middle name:

Last name:

Country:

Address lines:

City:

State:

ZIP:

Phone:

Email:

Confirm Email:

Payment Information

Payment Method:

Credit Card

Direct Debit

Cardholder's Name:

Credit Card Number:

Card Type:

Valid From:

/	(Maestro/Switch/Solo only)

Card Expiration:

Issue Number:

(Maestro/Switch/Solo only)

Card Security Code:

Note: The Card Security Code is not required for Maestro, Switch and Solo cards.