CBS Community Center Payment Form

RAJE PAYMENTS

CBS COMMUNITY CENTER
Type of Giving*
Please be sure to enter the proper amount below and also fill in a description at the bottom of this form.

Payment Amount*

USDPlease enter a description for this payment in the details section below:

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Payment Information
E-mail
Who is this Payment for?*
Description Of Payment*
By clicking the submit button below you agree to make a payment of the above amount to CBS Community Center. Please only click the submit button once. Once the payment is processed you will receive an email receipt to the address you entered. Thank You.
Should be Empty: