Vertigo Dance Association

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International Circle of Friends and Patrons

"The institution tax approval contribution under section 46 of the ordiance"

DONATION DETAILS

Friend — 2,500.00 $

Colleague — 5,000.00 $

Partner — 7,500.00 $

Patron — 10,000.00 $

Open amount

Donation Sum

Quantity

Payments

Delivery

Amount 2,500.00 $

2,500.00$ in each payment

RECEIPT DETAILS

Email *

Email Verificacion *

Name *

Company Reg. No.

Address

State

City

Mobile Phone *

Other Phone

ADDITIONAL DETAILS

Address to send a receipt

Payment method

Credit Card

PAYMENT METHOD

Card Owner Name *

Email*

Mobile Phone*

Credit Card Number *

Expiration Date *

Security Digits (CVV) *

Card Owner ID

I have read and agree to the terms & conditions

Thank you from Vertigo

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