Birth Houston General Donations

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$10

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First Name

Last Name

This donation is on behalf of a company

Phone

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Address

Address 2

Postal Code

City

State / Province

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CARD PAYPAL BANK TRANSFER

Card Number

MM / YY

CVC Code

The 3-4 digits on the back of your credit card

Billing ZIP Code

Enter the Zip/Postal code for your credit card billing address

By clicking Donate, you authorise BIRTH HOUSTON to debit the bank account that you connect to for any amount owed for charges arising from your use of BIRTH HOUSTON’ services and/or purchase of products from BIRTH HOUSTON, pursuant to BIRTH HOUSTON’ website and terms, until this authorisation is revoked. You may amend or cancel this authorisation at any time by providing notice to BIRTH HOUSTON with 30 (thirty) days notice.

If you use BIRTH HOUSTON’ services or purchase additional products periodically pursuant to BIRTH HOUSTON’ terms, you authorise BIRTH HOUSTON to debit your bank account periodically. Payments that fall outside the regular debits authorised above will only be debited after your authorisation is obtained.

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Account Type

Account Last 4

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