Donation Form

Pennsylvania Biotechnology Center tenants: please use this form for rent payments and conference room rentals.

Payment

Amount

$500 Rent

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Work Phone

Processing Fee Disclaimer

Simply leave "Yes!" checked below to ensure that 100% of your payment is available to the Pennsylvania Biotechnology Center.

Yes! I agree that paying by card means $0.00 will go to Pennsylvania Biotechnology Center and I will cover the processing fee of $0.00.Please leave the "Yes" checked above. If you do not wish to cover the processing fee you MUST chose another form of payment, check or wire transfer. You cannot opt out of the processing fee if you wish to pay by card.

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

Privacy Policy
We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited to your account.