Secure donation form

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	Home Work


* Address:

* City/Town:
* Country:
* * * * Province/State:
* Postal/Zip Code:
Phone number:	( ) Ext.
Cell phone number:	( )
* Email address:
* Confirm email address:

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* What is your relationship to Saint Mary's?

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Donor Recognition

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* * Donation amount:	$50 $150 $500 $10 per month $25 per month $100 per month Other Other
* Processing date:
* Number of installments:
	installments
Pay using PayPal
* Credit card type:
* Credit card number:
* Card security number:	Where is my card security number?
* Cardholder's name:
* Credit Card Expiration:


* Bank name:
* Bank ID:
* Cheque number:
* Transit number:
* Account number: