Donation Agreement
ADC can
automatically process your donation by credit card (VISA or MC) or
debit card. Please complete the following information.
Name of Donor:
___________________________________________________
Name on Credit Card
(if different): _____________________________________
Credit Card Number:
_____________________________________
VISA
_____ MASTERCARD _____
Expiration Date:
________ CID Code (3 digit on back of card): ______
Billing Address of
Card: ________________________________________
____________________________________________________________
|
Single Donation
Amount: _________________
|
Monthly Donation
Amount: ____________/ Month
Number of Months: __________
|
Signature:
_____________________________________________________
You
will be mailed a copy of the credit card receipt each month.
►
Your contributions are tax-deductible subject to IRS Ruling 501c3
◄
Federal Employees may also contribute thru the Combined Federal
Campaign by designating payroll deductions to Organization ID #5001.
