Donation through Credit Card

Please fill out the form below.

＊ Visa/MasterCard/American Express may be used.

＊Please note that your credit card payment will not be done after sending out this form.
Please be aware that this system uses the expression “invoice.”

Name (Required)

E-Mail Address (Required)

＊Please be sure information is entered accurately.

Staff or Ministry you would like to donate to (Required)

＊If you would like to donate to multiple staff or ministries, please:
　1) Leave the “Staff or Ministry” line blank
　2) Put the total donation amount in the “Donation Amount” line
　3) In the “Memo” section, please itemize the staff or ministries you would like to donate to, along with the amount for each one.

Donation amount (from 500 yen up to 500,000 yen) (Required)
￥

If you would like to give the above amount as a fixed amount monthly donation, please check the line, “Monthly Fixed Donation.”
Monthly Fixed Donation

　　　Please reply the following questions if you chose monthly fixed donation.

　　　Do you want a specific day to be the posting date?
　　　As soon as possibleI would like to choose the following day
　　 of every month

　　　Do you want to be given automatically?
　　　Yes, I want to be given automatically.No, I want to receive an email and do the process every month.

　　　＊If you desire to have a donation be given automatically every month, your credit card information must be saved in the system. Please check the box shown HERE in the invoice that will be sent to you later.

　　　Which month would you like to start?
　　　
　　　If you want to start from this month and the posting date you have chosen has passed,
　　　is it OK to charge you separately this month?
　　　 (For example: If you fill this form on September 20th and you chose the posting date 　　　to be 15th of each month. Then 　　　The first posting date will be between September 21st-30th. 　　　The second posting date will be October 15th and every 15th of the following months.)
　　　YesNo

If you have questions or other requests, please write them below.

＊Credit card donations will receive a “Completion of Payment” e-mail from the Payment Agency (Square), so you will not receive a “confirmation of receipt” from the JCCC office. Thank you for your understanding.
＊We are sorry, but donations to JCCC are not eligible for tax deduction.
＊Donations to JCCC are in yen only. Please be aware that credit cards issued in other countries will charge a “foreign currency conversion fee.”
＊Please confirm the accuracy of your information before sending.

Please answer the following question (required)
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