Payer Application
 Application Name: Breast Cancer - Online Donation
 Individual Or Business Entity Information
Trade or Individual Name(If applicable):
Physical Address(Trade or Home):
 Physical Address Line 2:
City:
State:
Zip:
Phone Number:
- -
Fax:
Email Address:
 Responsible Party Information
Last Name:
First Name:
 Payment Information
  Select the type of service        Credit Card Payment
 Amount:
 
    With Credit Card Processing Fee        Without Credit Card Processing Fee
  Donation Amount:  
  Credit Card Processing Fee:  
  Total Amount:  
  The New Jersey Commission on Cancer Research (NJCCR) charges a credit card processing fee of 2.00% of the donated
  amount plus $0.50, which donors can add or deduct from their gift by selecting one of the options above.  This fee is used
  to pay banks, credit card companies and other administrative costs.  The NJCCR does not profit from the fees.*

  *Once you know that there is a fee, you may wonder if giving directly to a cancer research organization would avoid all costs.
  However, the charities themselves incur fees when processing donations.  In fact, donating through the New Jersey
  Commission on Cancer Research may save these charities money because the Commission's processing fees are relatively
  low.  Many charities have to pay more to credit card companies.  Moreover, giving online saves the charity postage and
  check processing costs.
 Security Message:    
 Not Case Sensitive
 Enter Security Message: