ILDA Payment/Donation Form

ILDA Payment/Donation Form

Use this form for secure online credit card payments of invoices, sponsorships or donations to help ILDA.

If you are paying an invoice, enter the invoice number in the "Comments/Notes" area.
You can also pay by wire transfer. Please contact ILDA to ask for wire transfer information.

Preferred payment method

It is easiest for us to process credit card payments through PayPal. Note that you do not have to have a PayPal account in order to make a credit card payment through PayPal.

This method accepts Visa, Mastercard, American Express, Discover, eChecks and PayPal. Your credit card will be charged immediately using this method. After ILDA is notified of your payment, you will be sent a receipt via email.

Alternate payment method

Use the form below if you have any problems using PayPal. Your credit card information will be sent to ILDA via a secure, encrypted method. Later, we will process your credit card and send you a receipt via email.

AMOUNT OF PAYMENT/DONATION
USD $	(in US dollars, please)

COMMENTS / NOTES (reason for payment)

	Thank you for your payment/donation!

BILLING ADDRESS
Name:
Company:
Street Address:
City:
State/Province:
Postal Code:
Country
CONTACT INFO (in case of a problem)
Email:
Phone:
Fax:

CREDIT CARD INFORMATION
Type of Card:	Visa Mastercard American Express Discover
Card Number:
CVV/Security Code:	Visa/MC/Discover: 3 digits on back of card American Express: 4 digits on front of card
Expiration Date:	Month Year
Confirmation:	Yes, I authorize ILDA to charge my credit card for the Amount above

Before clicking the "Submit" button, please print this page and retain it for your records.

The above information is sent to ILDA via secure encrypted communications. We will decode the information and process your payment. You will receive an official email confirmation after your card has been charged (this may take two to three business days). Please contact ILDA if you have questions.