Corduro Payment

Personal Information

First Name: *

Last Name: *

Company:

Email: *

Verify Email: *

Email does not match

Address: *

Apt/Suite No.:

City: *

Country: *

State: *

Zip Code: *

Phone:

Customer Number: *

Invoice Number:

I would like to keep informed of what is happening.

Employee Information

Employee ID:

Department Name:

Work Location:

Membership

Membership Level:

select

Membership Description:

Membership Amount:

Member Number:

Student Number:

Class Year:

Birth Date:

Legal Verification

Occupation *

Employer *

I am a United States citizen or permanent resident alien.

This contribution is not made from the general treasury funds of corporation, labor organization or national bank.

Payment Options

Your gift will have a lasting impact! Select one of the following areas of giving or designate your own:

Donation

Other Purpose

Recurring Options

Please select the billing type below.

Monthly recurring billing

Yearly recurring billing

One time only

Payment Amount

Please enter the amount you wish to pay:

Amount

Convenience Fee

$ 0.00

Total Amount

$ 0.00

False

Who would you like to the gift in honor of?

Please let us know the name of the person you are generously giving on behalf of - (First Name and Last Name, contact info fields).

Title
First Name
Last Name

Who would you like to receive the acknowledgement of your kind gift?

Corduro Network will send a personal note regarding your gift to your honoree, or other person of your choosing, within 24-48 hours.

I would like to give anonymously.

First Name

Middle Name

Last Name

Address

City

Country

State

Zip/Postal Code

Your Note

What would you like to say in the acknowledgement? Sometimes words are hard, so we have some pre-written messages that might be helpful. If you prefer your own words, enter your short (255 character) note in the "Message" box instead. Special characters such as #, $ and & will distort the note, so you might not want to use them.

Email: *

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