Donor Denotes required field Your Payment One-time Recurring You can choose a recurring payment to be perpetual, or end after a specific number of payments. Perpetual? Frequency WeeklyBiweeklyMonthlyQuarterlySemiannuallyYearly # of Payments Your Amount $10.00 is the minimum online payment. I would like to include an extra $0.85 to help offset fees. Your Total Payment Amount $10.00 Your Total Payment Amount (Total includes processing fee of $0) $10.00 (Approx. $10.00) Payment This payment is being made on behalf of a company/organization. Security is of paramount importance to us. Your payment information is processed securely via Level 1 PCI DSS Compliant Service Provider. Credit Card Number Exp. Month MonthJanuary (01)February (02)March (03)April (04)May (05)June (06)July (07)August (08)September (09)October (10)November (11)December (12) Exp. Year Year2022202320242025202620272028202920302031 CVV Number Prefix PrefixAtty.Dr.MissMr.Mrs.Ms.Prof.Rev. First Name Last Name Suffix SuffixEsq.IIIIIJr.Sr. Email Confirm Email Phone Phone Type Phone TypeHomeMobileOtherWork Company Name Street Address Apt, Suite, Bldg. City State/Province/Region Select State/Province/Region Zip Code/Postal Code Country United States Additional Information Do you work for a company that will match your gift? Company that will match this gift Matching percentage, if known If this is a tribute gift, such as a gift in honor or memory of someone, please select Yes to provide details Tribute Type Select Tribute Typein Honor ofin Memory ofin Name ofon Behalf of In Tribute Of Name Tribute Notification First Name Tribute Notification Last Name Tribute Notification Informal Salutation Tribute Notification Email Tribute Notification Address1 Tribute Notification Address2 Tribute Notification City Tribute Notification State Select State/Province/Region Tribute Notification Zip Tribute Notification Country Select Country Tribute Notification Notes Donation Information Please check the box to make your payment anonymous Please opt-in to the types of email communication that you would like to receive from us: Default Fundraising Newsletters Year-end Tax Letter Please verify that you are not a robot. Submit Pay 25149 Smokewood Way, Stevenson Ranch, CA 91381, United States https://amorebalancedworld.org
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