Donation Form

Donation Form

Donor’s Name *

Billing Address *

Address Line 1

City

State

Zip Code

Email *

Phone *

ONE TIME PLEDGE AMOUNT:

Credit Card *

Name on Card *

Expiration *

Security Code *

Zip / Billing address *

Checkboxes *

Authorized signature

I authorize Youth Enlightenment System, Corp. to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. Please call (786)701-9432 for further information.

All donations are tax deductible. No goods or services are provided in return for this gift. Youth Enlightenment System, Inc. is a 501(c) 3 non-profit organization and registered with The Florida Department of Agriculture.

PLEASE NOTE: This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your credit card. We are a secured website certified by Trustwave.

Total

$ 0.00

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Donation Form

ONE TIME PLEDGE AMOUNT:

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