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Monthly Giving Enrollment Form
for debit or credit card transactions

Please complete the online form below to enroll in Lutherlyn's Monthly Giving program using your debit or credit card information.

If you are already enrolled in our Monthly Giving program using a debit or credit card please contact the Development Office directly (724-865-2161 or if you would like to update, change, or cancel your monthly gifts.  At this time our website cannot accurately process these changes.

If you prefer to provide your card information using a paper form, you can print, complete, and return the printable form below.

Contact Information

First and Last
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Lutherlyn requires a valid mailing address in order to provide an annual tax receipt.
Please use only numeric values in this field (for example, if you attempt to include "$" your form will not be submitted).
Credit Card Information
Visa MasterCard Discover

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

Make this a monthly payment?
Make this a monthly payment?
Your total payment will be
Your credit balance will cover
Your credit card will be charged
Your bank account will be charged

Please ensure you have checked the box above for "Yes, bill my card today and on the XXth of every following month." to make a monthly gift.

Your first monthly gift will be processed securely at the time you submit this form.  Subsequent gifts will be automatically processed monthly on this day of each month.  If you wish to have the date of your gift changed please contact the Development Office.  All enrollments are reviewed by a member of Lutherlyn’s staff who may contact you, in the event of an error or omission, using the contact information you have provided. 

If you have any questions please contact the Development Office at 724-865-2161 or