FORM for DONATIONS, PURCHASES, and PAYMENTS

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We are now able to accept credit cards. Print out this form, fill it in and fax it to the number shown below for a secure transaction.

Name (as it appears on your credit card):

_____________________________________

Billing Address:

_____________________________________________________

City:__________________________ State:_______ Zipcode:_________-______

Phone #:_____________________________

    VISA         MASTERCARD         AMERICAN EXPRESS (please circle one)

Credit Card #:__________________________________________

Expiration Date:_____/______

Amount: $_____________________

Purpose of this payment: __________________________________

Signature:_________________________________

Date:_________________