Greater Mt. Tabor Christian Center - GMTCC, Fort Worth, Texas
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CONTRIBUTION INFORMATION

Information as it appears on card:
First Name:
Middle Initial
Last Name:
Phone:
Card Type:
Card Number:
Expiration Date:

Month Year (ex. 2010)

Card Verification Number:

Billing Address:
Address 1:
Address 2: (optional)
City:
State:
ZIP Code: (5 or 9 digits)
Country:

Amount:
$ USD
Donation Type:
Comments / Prayer Requests: