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Organization Name*

Organization Website*

Organization Email*

Mailing Address*

City*

Country*

State/Province

Zipcode / Postal Code*

Your Firstname*

Your Lastname*

Phone Number*

Email address*

Do you currently accept Debit/Credit card payment for contributions?

Yes

Do you currently have a merchant account?

Yes

Do you manually process debit/credt cards?

Yes

Preferred Area Code (Text-2-Give / Messaging number)

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