Employee Insurance Payment ⋆ Association for Individual Development

AID Employee Insurance Payment

$ Donation Amount:

Custom Amount

Job Title

Personal Info

First Name *

Last Name

Email Address *

Comment

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Donation Total: $1.00

NOTE: You may be directed to a “Thank You for Your Donation” page. This payment is not a donation; a receipt will be e-mailed to you for your insurance payment. Please keep this for your records.