Please select your method of payment

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Credit Card


Amount (i.e., 35.00)


Pledge occurs


Number of Occurences


Comments




Name on Card


Chapter Name


Email Address


Billing Address


Billing City


Billing State


Billing ZIP code


Card Number (no spaces or dashes)


Month Expires (mm) eg. 03


Year Expires (yyyy) eg. 2015


Security Code

What's this?



By submitting this request you verify you have read and agree to be bound by Billhighway's Terms and Conditions. Additionally, by completing this process you recognize you are making an electronic signature in accordance with the Uniform Electronic Signature Act and acknowledge that you understand you are authorizing an electronic debit of funds from your (or an authorized) checking account or credit card (payer) to Billhighway, a payment provider representing your group (payee). You acknowledge that this transaction may cause you to incur additional service charges from your bank or credit card provider. You also hereby authorize and accept full responsibility for any negligent claims, disputes, refunds or fraudulent use that may arise from your usage of this service.


Electronic Check



Amount (i.e., 35.00)


Pledge occurs


Number of Occurences


Comments




Name on Check


Chapter Name


Email Address


Routing Transit Number

What's this?


Account Number


Check Number

By submitting this request you verify you have read and agree to be bound by Billhighway's Terms and Conditions. Additionally, by completing this process you recognize you are making an electronic signature in accordance with the Uniform Electronic Signature Act and acknowledge that you understand you are authorizing an electronic debit of funds from your (or an authorized) checking account or credit card (payer) to Billhighway, a payment provider representing your group (payee). You acknowledge that this transaction may cause you to incur additional service charges from your bank or credit card provider. You also hereby authorize and accept full responsibility for any negligent claims, disputes, refunds or fraudulent use that may arise from your usage of this service.



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