Kailua Lodge No 2230 BPO ELKS
Secure Payment Form
Donations
Order Date
Building Fund - $10.00
Elks National Foundation - $10.00
Major Projects - $10.00
Operations - $10.00
Scholorship - $10.00
TOTAL AMOUNT $
Credit Card Information
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
Pay By Check
Pay By Credit Card
Name as on Check
Bank Routing Number
Bank Account Number
Member Information
Member Name
Membership Number
Phone Number
Email Address
Submit
www.kailuaelks2230.org
For questions, please call at (808)262-0355
Supported by AXIA PAYMENTS HAWAII
