Kappa Alpha Order Donation Form

Omicron Chapter

These funds will be used to better our chapter in many ways. We greatly appreciate any donations that you are able to make.

Legal First Name:

Legal Last Name:

Email Address

Phone number

A payment receipt will be sent to the email address listed above for payments made via credit or debit card upon transaction authorization.

Card Type

Card Number

Name on Card

Card Expiration

CVV2:

Credit Card Billing Zip Code

Amount

Comments:

If you have questions, please contact:

Mitchell Greenberg

mitchellgreenberg9@gmail.com

(817) 687 - 8292