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

MobileMed 50th Anniversary Gala

Sponsorship Levels

Billing and Contact Information

First Name: *

Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/PostalCode: *

Phone:*

Additional Notes

Honor/Memorial Gifts

I want to dedicate my donation to someone:

In Honor Of In Memory Of Tribute To

In Memory Of:

Honoree Name:

Send Email acknowledgement to:

Send Postal Mail acknowledgement:

First Name:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

Zip/Postal Code:

Country:

Dedication Message:

Payment Details

CreditCard

Routing Number: *

Account Number: *

Check Number: *

Account Type: *

Check Type: *

Name on Card: *

Credit Card Number: *

Card Verification(CVV): *

Expiration Date: *

Invoice Number:

Purchase Order Number:

Name: *
Reference Number:

You will be charged:

Secured and Powered by Click&Pledge

October 14, 2018
5:30 pm – 8:30 pm

Since 1968, MobileMed has played a vital role in the lives of underserved Montgomery County residents, providing high-quality healthcare where and when they need us most, through our network of fixed-site and mobile van clinics. Today, MobileMed is a primary care medical home for thousands of low-income patients, with or without insurance, who rely on us, knowing they will be treated with respect, compassion, and integrity.

Advanced Redirect

MobileMed 50th Anniversary Gala

Your donation:

Sponsorship Levels

Billing and Contact Information

Honor/Memorial Gifts

Payment Details

Terms & Conditions

Matching Gift

You will be charged:

October 14, 2018
5:30 pm – 8:30 pm

For More Information

Processing...

Advanced Redirect

MobileMed 50th Anniversary Gala

Your donation:

Sponsorship Levels

Billing and Contact Information

Honor/Memorial Gifts

Payment Details

Terms & Conditions

Matching Gift

You will be charged:

October 14, 20185:30 pm – 8:30 pm

For More Information

Processing...

October 14, 2018
5:30 pm – 8:30 pm