Please fill out each area completely to assure accurate processing of your donation.
Credit Card Type: Visa MasterCard Amount: $
Full Name on Card:
Credit Card #:
3-digit security #: Expiration Date: Month January February March April May June July August September October November December Year 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Address (please include city, state, and zip code): Mr. John Smith 123 Main Street Anytown, CA 12345
E-mail address: Phone #:
Designation (if more than one, please list each separately with the amount): Church Planting - $100 GEM - $100
Would you like to make this a monthly gift? Select Yes No Which day of the month would you like us to debit your credit card? 1st 15th (for monthly gifts only)
All donations are tax deductible to the extent allowed by law. Your gift will be used as designated unless funds exceed the project's budget. Funds will then be disbursed at the Board's discretion.
