University of Houston Victoria

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Online Donations - Secure Donation Form

Campaign/Fund Information
Campaign/Fund *	Ed & Frances Bransford Endowed Scholarship or Select a Different Fund

Donation Information
Donation Amount *	OTHER: $
Payment Method *	Pledge ACH/E-Check (US banks only) Credit Card
Donation Type *	One-Time Donation Recurring Monthly Donation (until cancelled) Split this Donation into Monthly Payments
Number of Payments *
Pledge Installments
Why do you give?	We want to know why you give. Please provide us with a brief comment for our website that we may share with others. Use the donor comment box below, if needed.
Donor Comments

Donor Information

First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
Location	(Reset)
Postal Code*
Phone *

Billing Information
[ Click here if billing address is the same as donor address ]
Name on Card *
Card Type *
Card Number *
Card CVV Num *	What is this?
Exp. Date *	(format: mm/yyyy)
Account Type *
Account Number *	(confirm)
Bank Code *	(Routing Number)
Organization
Address *
Address Cont.
City/Town *
Country *
Location	(Reset)
Postal Code*
Billing Phone *

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