Episcopal Diocese of Northwest Texas Donation Form
Donations made here are received securely through the "Square" credit card application
Full Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State
Zip Code
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Is this donation a memorial or in honor of someone?
YES
NO
Information for Acknowledgement
Please indicate how you would like these funds to be used
Please Select
General Operating Donation
Youth
Disaster Relief
Bishop's Discretionary Fund
Credit card donations require us to pay a 3% processing fee. Can you assist us by covering all or a portion of this fee?
YES, I can add funds to the donation to cover processing fees
NO, not at this time
Donation Amount
prev
next
( X )
USD
Description
Credit Card
Submit
Should be Empty: