Payment by Credit Card

  1. STEP1 Entry
  2. STEP2 Confirmation
  3. STEP3 Completion

Gift Information

Donation Purpose
The University of Tokyo Hospital Foundation
-Purchasing the Latest Medical Equipment
-Fostering Medical Staff
-Improving Hospital Services/Environments
サポート先
Donation Purpose(Other)
Donation Frequency and Amount

I would like to donate the amount below at the following frequency:

  • (JPY)
  • (JPY)
  • (JPY)
  • (JPY)

Personal Information

Name First
Name
 
Last
Name
Address
City/State/ZIP
Country
Telephone Number
Email Address
Confirm Email Address
Affiliation
List of Donors

May we list your name in our newsletters, reports, etc ?



Name of Departments
Please specify diagnosis/treatment departments, if any that have inspired you to donate.
Advice and Proposal
Please enter any comments or questions.

Credit and Information

  • Payment by Credit Card

Transaction Process VISA, MASTER, MUFG CARD, DC, UFJ card, NICOS

visa master mufg dc ufj nicos jcb amex diners


● Credit Card Number

  • * 012345678999999

● Card Expiry Date

/   * Expiration Month:Expiration Year

● Card Verification Code

*123

It's the last three digits in the signature area on the back of your card.

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How to Donate by Credit CardHow to Donate by Credit Card



After completing the above donation application form,
please confirm Explanation of Donation Procedure and click "Input Confirmation".