Donation Form

Order Information

Company name:	Customer ID:	New
First name*:	Last name*:
Phone:	Alt phone:
Email:	Alt email:
Note to ICL:

Payment Information

Payment amount:
Recurs:
Payment date:

Choose Payment Type:

Credit Card

ACH (eCheck)

Credit card accounts (optional)


Card type*:
Card number*:		CVV2 Code*:
Expiration date*:		What's This? CVV2 Code is the 4 digit number printed above your American Express Card account number on the front of your card or the last 3 digits of the number located on the back of your Discover, MasterCard, or Visa card. This number is not required, but you have the option to enter it as an additional security protection.
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Billing Address

Address 1*:
Address 2:
City*:
State/Province*:
Country*:
ZIP/Postal Code*:	Help Do not use spaces when entering ZIP/Postal Codes

Create Account

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Terms and Conditions

I authorize ICL to debit the bank account or credit card indicated in this web form, for the noted amount on today’s date. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted transaction date. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that ICL may at its discretion attempt to process the charge again within 30 days. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card or bank account, and that I will not dispute the payment with my Credit Card Company or Bank, so long as the transaction corresponds to the terms indicated in this web form.

I accept the terms and conditions

Islamic Center of Livermore CA
379 South Livermore Ave
Suite C
Livermore, CA 94550
(925) 315-7402
icl@iclivermore.org
https://www.iclivermore.org/

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