Go Global Payment

Thank you for your prayers and generous support of the MNU Go Global Program! This form will assist you with the details of providing your support.

Payments are designated for the personal benefit of a Go Global participant and are not deductible for federal income tax purposes. Refunds are subject to MNU's Go Global refund policy.

 

Payment Information
Amount:	$ 25.00 $ 50.00 $ 75.00 $ 100.00 Other $     *
Additional Information
In the box below, please provide the participant code provided on the letter
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
Participant Code
Billing Information
Title:	Dr. Miss Mr. Mrs. Ms. Rev.	*
Cardholder's first name:		*
Cardholder's last name:		*
Country:	ALBANIA ARGENTINA AUSTRALIA AUSTRIA BAHAMAS BELGIUM BELIZE BERMUDA BOLIVIA BRAZIL BULGARIA CANADA CHILE CHINA COLUMBIA COSTA RICA COTE D'IVOIRE CZECH REPUBLIC DENMARK ECUADOR EL SALVADOR ETHIOPIA FIJI FRANCE GERMANY GHANA GREECE GRENADA GUAM GUATEMALA GUYANA HONDURAS HONG KONG INDIA INDONESIA IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN KENYA LEBANON MACEDONIA MALAWI MEXICO MICRONESIA MONGOLIA MOZAMBIQUE NETHERLANDS NEW ZEALAND NICARAGUA NIGERIA NORTHERN IRELAND NORWAY OMAN PAKISTAN PALAU PAPUA NEW GUINEA PERU PHILIPPINES POLAND REPUBLIC OF KOREA REUNION ROMANIA RUSSIA RWANDA SAINT VINCENT AND THE GRENADINES SAMOA SOUTH AFRICA SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN TANZANIA THAILAND TRINIDAD TURKEY UNITED KINGDOM United States VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. ZAMBIA ZIMBABWE	*
Address lines:		*
City:		*
State:	<Please Select> AA AE AP AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AB AS BC CZ DF FM GU MB MH NB NL MP VI NT NS NU ON PW PR PE QC SK YT Jap RJ `KS PQ	*
ZIP:		*
Phone:		*
Email:		*
Payment Information
Cardholder's Name:		*
Credit Card Number:		*
Card Type:	Visa American Express Discover MasterCard	*
Card Expiration:	01 02 03 04 05 06 07 08 09 10 11 12  / 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031	*
Card Security Code:		*