Help Ship Medical Supplies

Advanced Redirect

The patron will be redirect to the following pages based on the authorized result.

Important Note:

The redirect pages have to be secure otherwise no redirect will occur.
If your server is offline for any reason the redirect will fail, resulting in error. If the patron experiences a page not found based on your server’s availability it may result to double charges

Use complete URL including https://

Success landing page * :

Declined landing page * :

The following URL parameters are included in the response and may be used on the landing page via custom programming:

Example Success URL:
https://yourpageurl.com/success-page?on=123456&result=success&response=authorized&t=totalamount&refid=referenceid&trk=tracker

on = OrderNumber
result = success
response = authorized
t = totalamount
refid = referenceid
trk = tracker

Example Decline URL:
https://yourpageurl.com/decline-page?on=123456&result=failure&response=dcl&t=totalamount

on = OrderNumber
result = failure
response = dcl
t = totalamount

Help Us Send Precious Medical Supplies to Poverty Zones

We need your help shipping boxes of donated medicine and supplies to health clinics in poverty zones! It only costs $33 to send a box of life-saving treatment to leprosy patients in need!

Please make a gift today with God’s love in your heart!

Recurring Option

One time onlyMonthly

Billing and Contact Information

First Name: *

Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/PostalCode: *

Phone:*

Full Name

Honor/Memorial Gifts

I want to dedicate my donation to someone:

In Honor Of In Memory Of Tribute To

Send Postal Mail acknowledgement:

Payment Details

Credit Card eCheck

Routing Number: *

Account Number: *

Check Number: *

Account Type: *

Check Type: *

Name on Card: *

Credit Card Number: *

Card Verification (CVV): *

Expiration Date: *

CardExpirationYear

Invoice Number:

Purchase Order Number:

Name: *

Reference Number:

Charge Date

Charge me on: Payment will be processed and your card will be charged on this date

You will be charged:

Secured and Powered by Click&Pledge

P.O. Box 5002, Hagerstown, MD 21741
PHONE 800.543.3135
www.leprosy.org

Advanced Redirect

Your donation:

Honor/Memorial Gifts

You will be charged:

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