Payment Options:
*
One-time Immediate Gift of $5000
All recurring options below are for a
5-year
period
$83.34/Month
$250/Quarterly
$1000/Yearly
First Gift Date:
*
January
February
March
April
May
June
July
August
September
October
November
December
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
2025
2026
Would you like to make this a:
Memorial Gift
Honor Gift
Donation
Name of whom your gift is in memory/honor of:
Additional instructions:
500
characters left
Payment Methods
*
Credit Card or Check/
Debit Card
Bank Account Transfer
(ACH)
Card Number
Security Code
(CVV2)
Expiration Date
1 - January
2 - February
3 - March
4 - April
5 - May
6 - June
7 - July
8 - August
9 - September
10 - October
11 - November
12 - December
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
Account Type
(U.S. Banks Only)
Checking
Savings
Account Number
Routing Number
Your Information
First Name
*
Last Name
*
Company
Title/Position
Billing Address
*
City
*
State
*
AL
AK
AS
AA
AE
AP
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
*
U.S. Phone
(
)
-
Email
*
All donations provided to
Scottish Rite Charities
comply with U.S.
laws and regulations.
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Scottish Rite Charities
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