Credit Card Payments or Donations

Please complete this page, print, and mail directly to:

Tampa Lighthouse for the Blind, 1106 W. Platt Street, Tampa, Florida 33606, Attn:  Store Manager for Purchases or Development Dept. for Donations

Enter Your Credit Card Information  Your information will be kept secure and private.

Location:  United States    Other:

First Name:             Last Name:

Amount: $                                 Credit Card: VISA MasterCard Discover American Express

Credit Card #:        Expiration Date:       (mm/yyyy)

Billing Address (where you receive your credit card bills)

Address:

City:       State:           Zip:  

Telephone: ()           

Is this a payment for merchandise ordered?  yes 

(If yes, attach order form to payment).

Is this a donation to Tampa Lighthouse?  yes 

Please check one:

Winter Haven’s Programs   Tampa’s Programs

Thank you for your payment and or donation.  We will mail you a receipt.