United Way of Southwestern Indiana Logo
Registration Type
Registration Type
Select Option
Individual Golfer - $300 ea
Foursome - $1,200 total
Enter Payment Amount
$300
$600
$1,200
Other
Donation Amount
$
Golfer
First Name
Last Name
Mobile Number
Email
required
Address
Zip
required
I would like to play with:
Golfer #2 Name
Golfer #3 Name
Golfer #4 Name
Payment Information
Pay With
Apple Pay
Pay With
Credit Card
Pay With
PayPal
This is a secure 256-bit SSL encrypted payment
Routing Number
required
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Account Number
required
What is this?
Account Type
checking
savings
Name on Account
OK
Card Number
required
Expiration Date
required
Select a credit card type.
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This field is required.
Expired Credit Card
CVV
required
What is this?
Discover, Mastercard, Visa
3-Digit Card Verification Number
American Express
4-Digit Card Verification Number
OK
I would like to cover the payment processing fee.
Donor hereby approves the payment of the charitable donation and/or purchase to United Way of Southwestern Indiana and in the amount set forth herein.
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