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FACTPAC Donation
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*
Billing Information
First Name:*Same name as on your card
Last Name:*
Company
Address Line 1:*Where your statement is mailed
Address Line 2:Apt. or Suite No.
City:*
State:*
Zip Code:*
Phone:*
Organization Represented
Donation Information
Donation Level*
Diamond Club $500
Gold Club $250
Silver Club $100
Supporter Club $50
Other $
Donotion Type*Prefer individual donations
Anonymous Donation
Do not list name as donor
Gift Amount*Amount of donation
Payment by PayPal will be available on next screen. If you do not wish to use credit card you can print page and mail donation to:
FACT
PO Box 202197
Austin, TX 78720
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