The Vision Project
Please fill out this form and click submit.
Name
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Email
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Phone
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Address
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I would prefer to make a monthly gift (or skip to the bottom of this form for a one-time gift).
I give Victory permission to charge/debit my card every month. I understand that at anytime, I can stop payment by emailing or calling Victory.
Please select all that apply.
Yes
Full Name on Card
Billing Address
Credit Card Type
Please select one option.
Visa
MasterCard
American Express
Discover
Credit Card Number
*
Expiration Date (MM/YY)
Card Identification Number (3 digits on the back of the card or 4 on the front for Amex)
Amount to the charged monthly
I authorize Victory to charge the amount listed above to the credit card listed on this form. I agree to pay for this purchase in accordance to the issuing bank cardholder agreement. (Please date and put your signature in the box to confirm you agree with this monthly transaction.
One-Time Donation
Donation Amount (Please enter your one time gift amount.
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
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AZ
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CA
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CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
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