Nyx Donation Form

Since there is no program or script associated with this form the information entered will not be transmitted over the internet (notice there is no 'submit' button). Of course this is only true if your browser is running on your computer, not if you are telnetting in and running lynx.  If you are using lynx go HERE for a form you can print, fill out, and mail.

Personal Information

Name            

Address          

City, State, Zip

Nyx Username

Credit Card Information

Donation Amount:   US$

Card Type:       Visa         Mastercard

Name on Card:    

Account Number:  Expiration Date

          Automatic donation       Monthly      Bimonthly      Quarterly

          Stop automatic payments on this date:

                    Signature: ______________________________

Last updated 3 June 97