ePay Form: Institutional Advancement

Secure Payment Form

Date: 05/26/15
Payment Amount: (No dollar sign)
Type of Payment:

Click on button to select one of the following:

Donations / Gifts:
Benedict College Annual Fund
Benedict College Gospel Choir
Benedict College Marching Tigers Band Uniform Fundraiser
Mather School Fund
President's Circle - Purple Seat
Reunion Class Gift

Charter Day Tickets - Presenting $25,000
Charter Day Tickets - Benefactor $15,000
Charter Day Tickets - Trustee $10,000
Charter Day Tickets - President $6,000
Charter Day Tickets - Contributor $3,000
Charter Day Tickets - Patron $1,500
Charter Day Tickets - Individual $150
Charter Day Tickets - Individual Faculty and Staff $50

Payment on an Existing Endowed Scholarship:
Alumni Class Year (YYYY):
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Street Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
[What is the Card ID?]
Mailing Information (Required ... please fill in):
Company Name:
First Name:
Last Name:
Address Line 2:
Phone Number:
Email Address: