Payment Form

Resident Rental Payment Page

Payment

Amount

$40

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Work Phone

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

Upon completion, you'll see that the gift amount is listed as $0. We legally cannot insert a value - it is up to you to declare the value of your contribution of goods - you can update this value later for your records.

Vision House Federal Tax ID# 91-1493474

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.