TBS Century Club

To make changes to monthly payment plan, please contact Di Spiva at National Headquarters at 405-372-2333.
NOTE: The date your account will be charged each month is based on the date of submission of this form.

$ Donation Amount:

Make this donation monthly

Maiden Name (if applicable)

Address

Address 2

City

State

Zip code

Home Phone

Cell Phone

Chapter

School

Year you were initiated

Select Payment Method

Authorize.Net - eCheck
Authorize.Net - Credit Card

Personal Info

First Name *

Last Name

Email Address *

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Donation Total: $9.00 Monthly