Donation Form (Credit Card)
*BURL GALLERY is a 501(c)(3) tax-exempt organization. EIN: 56-2654340
Name
*
First Name
Last Name
Address (for sending donation acknowledgement letter, tax-exempt donation)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Donation Amount
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next
( X )
USD
*NOTE: Field labeled "12345" is for ZIP CODE.
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: