Brantley Balloons

Use this page to make a donation to the Lake Brantely Peer Counseling team. All donations are given to local organizations and families in need in the local area. You can donate any amount and you will be e-mailed a receipt for your donation.

Billing Information - Exactly as it appears on your Credit Card

*
Company Name:
Cardholder First Name: *
Cardholder Middle Initial:
Cardholder Last Name: *
Suffix (eg: Jr, Sr, II):
Billing Address:
Apartment or Suite:
Billing City: *
Billing State or Province: *
Billing Postal/Zip Code: *
Billing Country: *
Day Time Phone Number:
Mobile Phone Number:
Credit Card Type: *
Credit Card #: *
Expiration Date: * *
CVV Code: *
E-mail Address: *
Donation Amount: $*

*=Required Field

Click 'Finalize and Process Order' to complete your transaction. (Please note that transactions are not complete until you finalize the order.

To complete this transaction and to authorize the amount entered above to be charged to your credit card please select 'Finalize and Process Order'. To Cancel your donation, select 'Cancel Donation' and this transaction will not be processed.

Please allow 5 to 25 seconds for processing.

In order to curb the fradulent use of credit cards, we have instituted a policy of recording the customer's IP Address with their order. We have noted that your IP Address is We will prosecute those who fradulently use credit cards.