Temple Beth Elohim Donation Form

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

Amount

Donor Information (Please only use one name and the Second Donor can be identified below)

First Name *

Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/Postal Code: *

Phone:*

Full Name

Recognition

I/we would like our name(s) listed as: *

Please select below the fund you wish to donate to. *

Is there a TBE gift drive you are supporting?

Would you like to make this gift a tribute in honor or in memory of someone?

YesNo

Type of Tribute

HonorMemorial

Honor / Memorial Name

Is there someone you would like us to notify of this tribute? *

YesNo

Person (s) to address for the Tribute Notification *

Honor / Memorial Message included in Tribute Notification

Is the tribute recipient a TBE member?

YesNoI do not know

How would you like the Tribute Notification sent for the honorary gift? *

Email for person to receive Tribute Notification: *

Mailing address for Tribute Notification *

Honor/Memorial Gifts

I want to dedicate my donation to someone:

In Honor Of In Memory Of Tribute To

Send Postal Mail acknowledgement:

*If your donation is in honor or in memory of someone:
All tribute acknowledgments are sent electronically to the honoree/honoree's family. If you're unable to provide an email address, we will mail a physical card within 5 business days.

Payment Details

Credit Card

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:

Advanced Redirect

Your donation:

Honor/Memorial Gifts

You will be charged:

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