Florida Nurses Association

Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund *	Florida Nurse Political Action Committee (FNPAC) or Select a Different Fund

Donation Information
Donation Amount *	$
Payment Method *	ACH/E-Check (US banks only) Credit Card
Donation Type *	One-Time Donation Recurring Monthly Donation (until cancelled) Split this Donation into Monthly Payments
Number of Payments *
Donor Comments

Donor Information

First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
State	(Reset)
Postal Code*
Phone *

Billing Information
[ Click here if billing address is the same as donor address ]
Name on Card *
Card Type *
Card Number *
Exp. Date *	/
Account Type *
Account Number *	(confirm)
Bank Code *	(Routing Number)
Organization
Address *
Address Cont.
City/Town *
Country *
State	(Reset)
Postal Code*
Billing Phone *

By checking the box below you are agreeing to pay the Florida Nurses Association (FNA) the above sum. If this is a dues transaction, then you are agreeing to pay the full amount of membership dues as outlined in this invoice. If you have selected an Automatic Renewal membership plan (monthly, semi-annual, or annual), you are authorizing the Florida Nurses Association to charge the membership dues amount to your account using the credit/debit card or ACH banking information you provided on the 1st day of every month for monthly memberships, every 180 days from the date renewed for semi-annual memberships, or every 1 year from the date renewed for annual memberships. If you did not select an Automatic Renewal membership plan, your membership will not automatically renew and you will need to renew it at the end of your membership term to remain an active member. FNA is authorized to change the amount collected by giving you 30 days written notice. You may cancel or modify this authorization by written notification to FNA within 30 days prior to your next scheduled deduction date.

I Accept the Terms of Use

The Cardholder stated above has authorized this payment. If this payment is part of a recurring series of payments, the Cardholder understands the terms and amounts of those recurring payments, and authorizes payment for each of them. Cardholder consent will expire once all scheduled recurring payments have been processed, or if all future recurrences are cancelled. The Cardholder acknowledges that specific payment dates may vary. Examples include, but are not limited to: payment dates falling during weekends, holidays, or during system outages. In order to facilitate the processing of those recurring payments, stored credentials will be used. Those stored credentials will only be used to process payments that are part of this series of recurrences. In order to use those stored credentials for any other payment, Cardholder re-authorization will be required. In the event that a consent agreement must be modified, the new agreement will be sent to the email address associated with the invoice.

The Cardholder understands the terms and authorizes the payment(s).

Saving your donation details...

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