Bay Shrine Club

If you would prefer to make a donation by check or phone, please contact our Recorder:

Robert Berteau

Recorder

Office: (440) 546-9866
Cell: (216) 337-9849

To pay by credit card, please submit the form below.

Name*

First Last

Member Number

Email*

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payment Amount*

Payment Reason*

Payment Details*

Second Payment

Payment Amount #2*

Payment Reason #2*

Payment #2 Details*

Third Payment

Payment Amount #3*

Payment Reason #3*

Payment #3 Details*

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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