Donation Form

Payment

Amount

Name of Student

Please choose what week(s) you are attending

Parent or Guardian Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Work Phone

Student Information

Student Full Name

Current Elementary School

Incoming Grade

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

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Terms/Conditions
By submitting your payment, you authorize us to charge the account above for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your pledge.

*All Gifts to Fontbonne are tax-exempt to the fullest extent of the law

Fontbonne Hall Academy

9901 Shore Road, Brooklyn, NY 11209

718.748.2244

www.fontbonne.org