Texas CASA (default)

Advanced Redirect

The patron will be redirect to the following pages based on the authorized result.

Important Note:

The redirect pages have to be secure otherwise no redirect will occur.
If your server is offline for any reason the redirect will fail, resulting in error. If the patron experiences a page not found based on your server’s availability it may result to double charges

Use complete URL including https://

Success landing page * :

Declined landing page * :

The following URL parameters are included in the response and may be used on the landing page via custom programming:

Example Success URL:
https://yourpageurl.com/success-page?on=123456&result=success&response=authorized&t=totalamount&refid=referenceid&trk=tracker

on = OrderNumber
result = success
response = authorized
t = totalamount
refid = referenceid
trk = tracker

Example Decline URL:
https://yourpageurl.com/decline-page?on=123456&result=failure&response=dcl&t=totalamount

on = OrderNumber
result = failure
response = dcl
t = totalamount

Recurring Option

One time onlyMonthlyQuarterly

Billing and Contact Information

First Name: *

Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/PostalCode: *

Phone:*

Full Name

Is this gift anonymous?

Select "yes," and your name will not be listed in public donor listings. You will still receive a personal acknowledgement for your donation.

Do you have a special purpose for your donation?

Please select the type of donation dedication

Please send an additional acknowledgement.

Texas CASA will send an acknowledgement to the individual or organization to whom you are dedicating your donation. Please provide the name and mailing address of the recipient.

Honor/Memorial Gifts

I want to dedicate my donation to someone:

In Honor Of In Memory Of Tribute To

Send Postal Mail acknowledgement:

Payment Details

Credit Card Bank Account

By clicking [accept], you authorize Texas CASA, Inc. to debit the bank account specified for any amount owed for charges arising from this charge. You may amend or cancel this authorization at any time by providing notice to Texas CASA, Inc. with 30 (thirty) days notice.

You further authorize Texas CASA, Inc. to debit your bank account as part of your recurring commitment. Payments that fall outside of the regular debits authorized above will only be debited after your authorization is obtained.

Name on Card: *

Credit Card Number: *

Card Verification (CVV): *

Expiration Date: *

CardExpirationYear

Invoice Number:

Purchase Order Number:

Name: *

Reference Number:

Matching Gift

Find out if your employer offers a matching gift program.

Advanced Redirect

Your donation:

Honor/Memorial Gifts

You will be charged:

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