Temple Beth Elohim Donation Form

Advanced Redirect

The patron will be redirect to the following pages based on the authorized result.

Important Note:

The redirect pages have to be secure otherwise no redirect will occur.
If your server is offline for any reason the redirect will fail, resulting in error. If the patron experiences a page not found based on your server’s availability it may result to double charges

Use complete URL including https://

Success landing page * :

Declined landing page * :

The following URL parameters are included in the response and may be used on the landing page via custom programming:

Example Success URL:
https://yourpageurl.com/success-page?on=123456&result=success&response=authorized&t=totalamount&refid=referenceid&trk=tracker

on = OrderNumber
result = success
response = authorized
t = totalamount
refid = referenceid
trk = tracker

Example Decline URL:
https://yourpageurl.com/decline-page?on=123456&result=failure&response=dcl&t=totalamount

on = OrderNumber
result = failure
response = dcl
t = totalamount

DONATION AMOUNT

RECOGNITION

I/we would like to be recognized as (first and last name(s)):

Please select below the fund you wish to donate to: *

Is there a specific giving drive you are supporting?

Would you like to make this gift a tribute in honor or in memory of someone?

YesNo

Type of Tribute

honormemory

In honor/memory of (full name):

Is there someone you would like us to notify about this gift?

YesNo

Name of person to notify:

Enter an optional tribute message below to be shared with this person/honoree/their family:

How would you like us to notify them of this tribute?

Email of person to notify of honor/memory tribute:

Mailing address of person to notify of honor/memory tribute:

BILLING INFORMATION

Billing First Name *

Middle Initial:

Billing Last Name: *

Primary Email: *

Billing Country: *

Billing Address: *

Billing City: *

Billing State: *

Province:

Billing Zip/Postal Code: *

Cell Phone:*

Full Name

Honor/Memorial Gifts

I want to dedicate my donation to someone:

In Honor Of In Memory Of Tribute To

Send Postal Mail acknowledgement:

Please note: If you are donating to Or Hadash through TBE, 100% of your gift will be sent to the 3rd party. TBE will share your information and all donation details with the 3rd party. If you wish to remain anonymous, please notify development@tbewellesley.org.

PAYMENT DETAILS

Credit Card

Name on Card: *

Credit Card Number: *

Card Verification (CVV): *

Expiration Date: *

CardExpirationYear

Invoice Number:

Purchase Order Number:

Name: *

Reference Number:

Advanced Redirect

Your donation:

Honor/Memorial Gifts

You will be charged:

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