Seattle Alumnae Chapter Payment Transaction Detail Form

Delta Sigma Theta Sorority, Inc. Payment Transaction Detail Form

This form must be completed and submitted to the Financial Secretary for the chapter to accept any payment(s) for items/donations other than dues. Please use the Dues Form for the payment of dues.
Contact Information

This information is required in case we need to contact you about the payment.
Date

MonthDayYear
Date
NAME
E-MAIL ADDRESS
example@example.com
What method of payment are you using?
Check #:
If you're paying by check, please enter the check number.
Money Order #:
If you're paying by money order, please enter the money order number here.
To pay with your credit card via Square, please know that there is a 3% transaction fee that will be added to your total below.
After completing the payment details below and submitting this form, please mail your check or money order to:

Seattle Alumnae Chapter
Delta Sigma Theta Sorority, Inc.
P.O. Box 28046
Seattle, WA 98118
Payment Details

If you are paying for multiple things, you can list each item below and submit only one form.
ITEM 1
Payment for:
ex: Scholarship Donation, 2nd Loving Hands, Holiday Baskets, etc
Amount:
ITEM 2
Payment for:
ex: Scholarship Donation, 2nd Loving Hands, Holiday Baskets, etc
Amount:
ITEM 3
Payment for:
ex: Scholarship Donation, 2nd Loving Hands, Holiday Baskets, etc
Amount:
ITEM 4
Payment for:
ex: Scholarship Donation, 2nd Loving Hands, Holiday Baskets, etc
Amount:
ITEM 5
Payment for:
ex: Scholarship Donation, 2nd Loving Hands, Holiday Baskets, etc
Amount:
TOTAL
This total is automatically calculated from your entries.
Hidden field to add Square fees

Credit Card Total

USD

Credit Card

FOR FINANCIAL SECRETARY USE ONLY
FOR FINANCIAL SECRETARY USE ONLY
Should be Empty:

Contact Information

Payment Details

ITEM 1

ITEM 2

ITEM 3

ITEM 4

ITEM 5

Credit Card Total

Credit Card