City:                                                             State:                          Postcode:

Phone:

                                 Total  

  $

  Text Box: REGULAR PERIODICAL PAYMENTS
Today’s date:                                               
r Master Card     r Visa r Bankcard / Cash r  / Check # r 
 
I am making a donation by cash or check as follows:
Please deduct         $
 
from the above credit card, commencing 
                 /                /
(Amount in words)
 
                                                                                                                            (Date)
r WEEKLY (Please specify day of week)
 
r MONTHLY (Please specify day of month)
 
until further notice.
 
 
 
 
 
 
 
Credit Card Number
                    
Expiration Date
Tithe/Contribution:
Amount
Cardholder Name: (Please print)
Building Fund
 
Signature: (Required)
Pledge
 
Name:
General Offering
 
Address:
Other: (Specify)
 
 
City:                                                             State:                          Postcode:
Phone:
                                 Total   
  $
 

PRINTABLE DONATION FORM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You may mail or fax this form.  See mailing address and fax number on feedback page.

 

 

 

 

 

 

 

 

 

 

 

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