Please fill out the form below to easily pay your Chai-A-Thon pledge. Billing Info First Name:* User ID # (from pledge card) Last Name:* Address:* City:* State:* Zip:* Phone:* Email: Credit Card Info Charge Amount: $ Comments (optional) Card Type: Please Select Visa Mastercard Discover American Express Card Number: Expiration: Select January February March April May June July August September October November December Select 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Pledges can also be mailed to: One University Plaza Drive - Suite 507, Hackensack, NJ 07601 This page uses 128 bit SSL encryption to keep your data secure.