Donor's Name
Class Of
Home Phone
Amount $ U.S. Currency
Please designate this gift to:
For Other Specify Here:
If Memorial Specify In Honor or In Memory of:

Please send acknowledgement of this gift to:

Country (If not, US):
Name on credit card
Card Holder Billing Address
Card Holder Billing City
Card Holder Billing State
Card Holder Billing Zip Code
Choose Credit Card Type
Credit Card Number (Number Only - No Dashes)
Card Verification Value (CVV2)
Credit Card Expiration Month(mm Format)
Credit Card Expiration Year(yy Format)

Note: The information submitted on this form is protected by a secure server and is encrypted between the server and the Office of Records and Receipts. If you have any questions, please contact the Office of Records and Receipts at (260) 665-4118. Thank you for your investment in Trine University. Follow the privacy link to learn about our privacy policy.