SECURE DONATION FORM

Unrestricted donations – Checks, Credit Cards, Cash, Large tracts of land. You give here simply because you love the ministry and want it to continue. Donations to Highlands Ministries, a 501 (c) (3), are tax-deductible.

	One time	Please charge me for a one time donation amount of minimum of $5
	Monthly	Please charge me a monthly donation amount of minimum of $5

ALL INFORMATION MUST MATCH INFORMATION ON CREDIT CARD

	*Required Information
	First Name*
	Last Name*
	Billing Address*
	City, State, ZIP*
	Billing Phone*		555-555-5555
	Email (Optional)		(Your receipt will be sent here)
	Credit Card Information
	Name on Card
	Card Number
	Card Type
	Expiration Date
	CVV2 Number		(located on back of card contains 3-4 numbers)

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You can also MAIL A CHECK TO:
Highlands Ministries
PO Box 16488
Bristol, Virginia 24209

*Donations to Highlands Ministries, a 501 (c) (3), are tax-deductible.