DTC Fall Fundraiser

Join the Westport DTC for our summer event at Rive Bistro on Wednesday, June 29th 7-10pm

Your donation:

Ticket Purchase & Host Opportunities

$120 - 1 ticket

$200 - 2 tickets

$250 - Host Committee - Individual

$500 - Host Committee - Couple

$1000 - Sponsor

Auction Item

Billing and Contact Information

First Name: *

Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/PostalCode: *

Phone:*

Full Name

Employment

Employer: *

Occupation: *

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

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:

Terms & Conditions

I hereby certify that I am NOT a principal of a state contractor or prospective state contractor, and that I am NOT a communicator lobbyist or a member of the immediate family of a communicator lobbyist.

I understand that Connecticut law requires that a contribution be in my name and be from my own funds.

I hereby affirm that this contribution is being made from my personal funds, is not reimbursed in any manner, and is not being made as a loan.

I further certify that all of the information set forth above on this form is true and accurate to the best of my knowledge and belief.

I agree with the terms and conditions.

You will be charged:

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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

Your donation:

Honor/Memorial Gifts

You will be charged:

Advanced Redirect

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