Potrang USA credit card donation

Donation Amount *

Total Amount

I want to contribute this amount every month

Your recurring contribution will be processed automatically. You will receive an email receipt for each recurring contribution.

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Comments

Consent to process your personal information

I give permission for the personal information in this form to be collected so my transaction can be processed. (In order to provide a tax receipt for your donation, Potrang will securely store this personal information as required by the regulations.)

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

To make a restricted donation to a specific project or fund (for example a tangra or puja donation), please use the Comments field and make your donation here. General Fund Potrang donations can also be made here.