Donor Information

Donation Information

Payment Information

Please fill out the form below and confirm your application below.


*Please Do NOT use your browser to move back or forward, between previous screens.


Donor Information* required field.

Name(as it appears on the card) * First    Family 
Postal / Area code *  -    
State / Province *
City *
Example: Minato-ku
Street *
Example: 6-10-11 Minami-Aoyama
Building
Example: Wesley Center, Room 203
Building
Street *
City *
State / Province *
Postal / Area code *
Country *
Phone Number *
(XXX-XXX-XXXX)
Email address *
Please enter again to reconfirm.
Company

Donation Information

Account Charged *
Donation Amount *


 Yen
Minimum Donation Amount is 1,000 yen.
Donating For *  
   ※Please insert Country/Region to support 
Donor Division *  
     Year of Graduation / Department : Subject / Postgraduate School : Major 
     
 
     Affiliation / Classification 
 
 
     School : Subject / Graduate School : Major 
 
     Name of Student / School : Graduate School / Year of Enrollment 
     
 
Permission to Publish *  
 
 

Payment Information

We accept the credit cards with the following brand marks. We accept the credit cards with the following brand marks.
Card number *
Please do not use hyphens or spaces.
Expire date *  Month  Year
Security code *   Security Code
Bank code *

振込先は決済代行会社「みずほファクター」と表示されます。
別途振込手数料がかかります。

Bank user_name *
全角カタカナで入力して下さい。
Convenience *
ご利用されるコンビニの変更はできませんのでご注意ください。

A message to the group you are donating to.

We do not use donors' personal information for any purpose other than fundraising, and we implement appropriate measures to ensure the security of all information provided.