SECURE PAYMENT FORM
Donation Summary
Donation Amount
Credit Card Information
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
Donor Information
Company Name
First Name
Last Name
Address
Address 2
City
State
Zip
Cell Number
Email Address
Employment Info
Contribution Rules
I am a U.S. citizen or lawfully admitted permanent resident (i.e., green card holder). This contribution is made from my own funds, and funds are not being provided to me by another person or entity for the purpose of making this contribution. I am at least eighteen years old.
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www.dukeaiona.com
Paid for by Friends of Duke Aiona. PO Box 3255 Honolulu, HI 96801.
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