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Donor Information
Title
Brother
Capt.
Captain
Chief
Col.
Dr.
Dr. and Mrs.
Drs.
Father
INACTIVE
LCDR
Lt.
Major
Master
Mayor
Most Rev.
Mr.
Mr. and Mrs.
Mrs.
Ms.
Pastor
Patient
Rabbi
Rev.
Saint
Sgt.
Sister
The
The Honorable
The Rev.
*
First Name:
Middle Name:
*
Last Name:
Company / Division
Billing Information
*
Email:
*
Phone Number:
*
Country:
Albania
Algeria
Antigua and Barbuda
Argentina
Australia
Austria
Bahamas
Barbados
Belarus
Belgium
Belize
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Bolivia
Bosnia
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Bulgaria
Burkina Faso
Burma
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Cameroon
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Cayman Islands
Chile
China
Colombia
Cook Islands
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Croatia
Cuba
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Democratic People's Republic of Korea
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Eswatini
Ethiopia
Fiji
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French Polynesia
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Kenya
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Kosovo
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Lebanon
Liberia
Malaysia
Mexico
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Nicaragua
Nigeria
Niue
Norway
Pakistan
Panama
Paraguay
Peru
Philippines
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Portugal
Puerto Rico
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Republic of Korea
Romania
Russia
Samoa
Saudi Arabia
Scotland
Scotland UK
Senegal
Serbia
Singapore
Slovenia
South Africa
Spain
St. Lucia
St. Thomas
St. Vincent
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Thailand
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Turkey
Turks & Caicos
USA
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Ukraine
United Arab Emirates
United Kingdom
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Venezuela
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Wales
Zimbabwe
*
Address 1:
Address 2:
*
City:
*
State/Province:
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Alaska
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Armed Forces Americas
Armed Forces Canada/Africa/Europe/Middle East
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
Dist. of Columbia
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Pennsylvania
Puerto Rico
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South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip/Postal Code:
In the future, it is Ok to contact me by Email
In the future, it is Ok to contact me by Mail
In the future, it is Ok to contact me by Phone
It is Ok to contact me for future donations
Payment Details
*
Name on Credit Card:
*
Card Number:
*
Type:
American Express
Discover
Master Card
Visa
*
Month:
01
02
03
04
05
06
07
08
09
10
11
12
*
Year:
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
*
CVV:
What is a CVV Code?
CVV Code is a security code used to protect your credit card and prevent fraudulent use.
Visa/MasterCard/Discover
The CVV Code is the last 3 digits immediately after your credit card number on the back of your card.
The CVV Code is located within the signature panel.
American Express
On American Express cards the CVV Code is the 4 digits above and to the right of your credit card number on the front of your card.
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RMHC of Mobile
1626 Spring Hill Avenue
Mobile, AL 36604
251-694-6873
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