Thank you for Updating your Credit Card Info!
Please complete the following form. Fields marked
*
are required.
Personal Details
*
First Name
*
Last Name
*
Street 1
Street 2
*
City
*
State
AE
AK
AL
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UM
UT
VA
VI
VT
WA
WI
WV
WY
*
Zip Code
*
Daytime phone
*
Email
May we contact you via email?
Yes
No
Your Monhtly Gift
How would you like to be billed?
Pay in full
Monthly
Semiannual
*
Sustaining pledge?
Yes
No
If you would like your sustaining plan to continue until you stop, please click this box
*
Payment Method
Credit Card
Bank Draft
Making your donation via bank draft saves WTCI credit card processing fees and allows you to keep your donation going without having to update payment information when a credit card expires.
Amount per payment
$5
$7
$10
$15
$20
Other
Specify the amount per period
Amount of your pledge
$60
$75
$100
$250
$500
$1000
Other
Other amount
Other amount per period
Bank Draft Information
Bank Routing Number
Bank Account Number
Savings Account?
Yes
No
Electronic signature (eg. /John Smith/ )
To confirm you have read our
EFT Policy
and agree to ongoing bank debits, please sign above in the format of
/First Last/ including the slashes.
Credit Card Information
Credit Card Number
Expiration Date
Format MM/YY
Let us know what WTCI means to you!
Comment
Errors above, please check and submit again
Thank you for your patience as we process your pledge. Hootie Hoo
For additional support or questions please call (423) 702-7819 or email membership@wtcitv.org
