Support Hospital Lumiere
Donation
Amount
Type of Gift
One Time Gift
Recurring Gift
Frequency
Monthly
Quarterly
Annually
Where would you like your contribution to go?
Haiti - Hospital Lumiere
HarvestCall General Fund
Servant Fund (supports missionaries)
Contact Information
First Name
Last Name
Address
City
State/Province
Zip/Postal Code
Home Phone
Work Phone
Email
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Help Us Cover Costs
Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available to proclaim Christ & serve others.
Yes! I want $0.00 to go to Apostolic Christian HarvestCall and I will donate $0.00.
No. I will donate $0.00 and Apostolic Christian HarvestCall will cover the processing costs.
Credit Card Information
Card Holder Name
Visa
MasterCard
Discover
AmEx
Card Account Number
Expiration Date
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
24
25
26
27
28
29
30
31
32
33
34
Security Code
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here
for CVV2 information
Billing Address
Same As Above
Address
City
State/Province
Zip/Postal Code
Email
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