Nickname
*
Please Wait...
Thanks for deciding to support our project.
Regions
Please Select a Regions Below:
Donation Amount
I would like to make this a pledge
I wish to donate
$25
$50
$100
Other
Or enter amount
*
NZD
I would like to pay $
to cover the processing fee
Start Date (1st or 20th only)
Next
Personal Information
Title
First Name
*
Last Name
*
Organisation
Pay on behalf of this Organisation
Email
*
Mobile
Phone
Date of Birth
Suburb
City
Country
Country
Search for your address
Search for your address
Enter Address Manually
Address
Address 2
Address 3
Suburb
City
Post Code
State/Region
Region
In Memoriam Donation?
Details
Comments
Back
Next
Payment Method
Pay using
Click to accept our Terms and Conditions
View Terms and Conditions
Name on card
*
Credit or Debit Card Number
*
Security code
*
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Account Holder
*
Account Number
*
Signature
*
Clear
Bank Account
By providing your bank account details and confirming this payment, you agree to this Direct Debit Request and the
Direct Debit Request service agreement
, and authorise Cancer Society of NZ Wellington Division Inc. to debit your account for any amounts separately communicated to you by the Merchant. You certify that you are either an account holder or an authorised signatory on the account listed above.
Click to accept our Terms and Conditions
View Terms and Conditions
Back
Submit
Please note that our payment processing partner, Flo2Cash, will conduct a temporary $1.00 NZD authorisation transaction on your card for authentication. This charge ensures a secure and smooth payment experience, and is refunded within five days.
Just a few last questions
Yes
No
Yes
No
Yes
No
First name
Last name
Email
Thank you we will be in touch shortly