General Donation & Payment Form


Welcome to the Great Wall China Adoption/Children of All Nations payment processing form. This form allows for simple transactions via credit card/debit card via our secure site to make donations to our charitable programs and for families contracted with our agency to conveniently make payments for contracted services. This form accepts Visa, Mastercard, and Discover. Please note if you are receiving a donation or grant through a third party, a standard processing fee will be deducted from the total amount. If you have any questions regarding payments you are making, please contact our business office during regular business hours at 512-323-9595.

We appreciate those who offer assistance to our adopting families with their adoption expenses. We graciously accept your contributions, however at this point we are unable to accept any contributions under $100. If you choose to make contribution under $100, there is a nominal processing fee for each contribution and we want to discourage you from making such contributions if the contribution is under $100. We encourage you to still contribute to the adoptive family, but in a different manner so that they will receive the full benefits of your contribution. We suggest gathering funds from other contributors and submitting one lump sum, or provide the money directly to the family. We thank you for your cooperation.

Please note that any contribution over $100 per transaction will be assessed a service and financial processing fee. Please contact our accounting department for detailed fee information prior to making the contributions.
 

Payment/Donation Information

Adoption fees and services:
     AGENCY FEES (per your signed contract)
      CHINA
        Conventional/Classic
          1st Agency Fee
          2nd Agency Fee
          Dossier & Wire Fee
          Dossier & Wire Fee (Waiting Child)
          3rd Agency Fee
          Dragon Dossier Service Fee
          Dragon Expense Retainer
          Dragon Expense Retainer Refill
          Twins Fee
          DS260 Filing Fee
          Post Adoption Agreement Fee
          Travel Fees (as indicated on invoice)
          Other
        Preferred/Premier
          1st Agency Fee
          2nd Agency Fee
          Dossier & Wire Fee
          Dossier & Wire Fee (Waiting Child)
          3rd Agency Fee
          Dragon Dossier Service Fee
          Dragon Expense Retainer
          Dragon Expense Retainer Refill
          Twins Fee
          DS260 Filing Fee
          Post Adoption Agreement Fee
          Travel Fees (as indicated on invoice)
          Other
        Elite/Executive
          1st Agency Fee
          2nd Agency Fee
          3rd Agency Fee
        Dragon Expense Retainer Refill
        Twins Fee
        Other
      CAN
        1st Agency Fee
        2nd Agency Fee
        3rd Agency Fee
        CAN Expense Retainer
        CAN Expense Retainer Refill
        CAN Referral Translation Fee
        CAN Translation Fee (Dossier)
        Foreign Govt 1st Fee
        Foreign Govt 2nd Fee
        Foreign Govt 3rd Fee
        International Special Care Fee
        Foreign Program Fee
        Agency Fee - Extra Child
        Foreign Program Fee - Extra Child
        CAN - Haiti Bonding Trip
        CAN - Post Adoption Deposit
        Other
    WAITING CHILD PROGRAM FEES
      2nd Waiting Child Fees
      Home Study (if apply)
      Waiting Child CCCWA Processing Fee (LOI)
      Waiting Child Orphanage Partner and CCCWA Processing Fee (LOI)
    AMENITIES
      Red Backpack
      Stork Goodies
      Visa Service
      Visa Service Expedite
      Medical Prescription
      Doctor on Call
      Orphan Announcement/Finding Ad
      Mobile Phone in China
      Travel Insurance
    ADDITIONAL SERVICES
      Medical Referral Program
        Prestige ($375)
        Elite Neuropsychology ($400)
      Home Study Update - USCIS
      Home Study Only - TX/FL ($1400)
      Post Adoption Report ($300 per Report) * $300
      VP Hague Filing Service
      Legacy Journey Application Fee
      Hague Courses
      Dossier Copy Fee
      Fed Ex Fee (Domestic)
      Fed Ex Fee (International)
      Other
Total Amount: $
For all above selections

General Donation:
Donation For:
Donation Amount:
 If you selected other, please specify the amount below.
Other Donation Amount: $
 minimum donation of $25
In Honor of:
  Send donation letter for tax purposes

*Your Full Name:
*Address:
Your Phone Number:
*E-Mail Address:

 

Billing Information

*Driver License #:
*Driver License State:
*Name as shown on your card:
*Select the card you are using:
*Card Number: - - -
*Expiration Date:  
*Credit Card Validation       Number (CCV):
*Billing Street:
*Billing City:
*Billing State:
*Billing Zip Code:
*Billing Phone Number: - -

By signing my name below I agree that any adoption fee(s) paid to Great Wall China Adoption DBA, Children of All Nations, as indicated above, is nonrefundable. I verify that by signing the above credit card authorization form, I choose to pay by credit card for all services listed above and agree to all terms and conditions stated within the accompanying signed Agreement(s) or form(s). I acknowledge and understand, should I choose to stop my adoption at anytime during the process, all fees rendered on the above form are non-refundable.

Total Amount Charged to Card: $
*Cardholder's Signature:

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