A Capital Valentine Donation Page Url Donate Now A Capital Valentine I would like to make a donation. I would like to be recognized as follows * Method of Payment: Pay Type * Credit Card (Visa, MasterCard, Discover, American Express, Diners Club) PayPal Amount * First Name (as appears on credit card) * Last Name (as appears on credit card) * Card # * Month * 01 02 03 04 05 06 07 08 09 10 11 12 Year * 17 18 19 20 21 22 23 24 25 26 27 28 CVV * Billing Info Address * City * State * ZIP * Phone * E-Mail * Contact Info Same as CC Same as above First Name * Last Name * Address * State ZIP * Company (if applicable) Title Questions? Call 614.224.1127 or toll free 800.232.6272; ocr@ohiocancer.org