Bedford Direct Donation

Donation form

Help raise money for our organisation.

Please provide your contact and payment information. The contact information is required to generate a tax receipt. The electronic tax receipt will be sent to the email address that you provide.

* denotes required information

Make personal donation:
Make donation on behalf of an organisation:

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Title:
* First name:
* Last name:

Contact information


	Home Work

Enter address manually
Company Name:
* Address:

* Suburb/Town:
* Country:
* * * State/Territory:
* Postcode:
Phone number:	( )
Mobile:
* Email address:
* Confirm Email Address:

Allow Bedford Group to contact me by email.
I give Bedford Group permission to contact me by mail (post).

Payment information

Pay using Credit Card
Card Security Number is not supported in data entry. To process a credit card payment, you need to disable Card Security from the Electronic Payment page in the Configuration tab.
Payment Method:
* Donation amount:
Did you know that by covering the processing fee, Bedford Group will be able to help more people?
I want to cover the fees for my donation ( %ProcessingFee% ).

* Processing Date:
	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:

Security Check

We have implemented an extra step in order to prevent Credit Card fraud. Unfortunately, some people use automated programs to test whether fraudulently obtained credit cards are valid. To counteract this practice we ask that you answer the question below.