The MinKwon Center for Community Action is a community-based, immigrant rights organization that depends on your participation and support. Join our movement for community action and support our work! All donations are tax-deductible.
|
Donor Information
|
|
Name
|
|
|
Billing Address
|
|
|
City
|
|
State
|
|
Zip Code
|
|
|
Phone
|
|
|
E-mail
|
|
Donation Amount
Frequency: [ ] One Time [ ] Monthly Recurring
I would like to give: [ ] $25 [ ] $50 [ ] $100 [ ] $250 [ ] Other_______
Source: [ ] Check/Cash [ ] Credit Card [ ] Bank Account
Payment Information
For One Time or Recurring Credit Card Donations Only:
Name on Card: ____________________________________________
Credit Card Type (Please circle one): Visa Mastercard American Express
Credit Card Number: ____________________________________________
Card Security Code: _____________________ Expiration Date: _______/_______/_______
For Recurring Bank Account Donations Only:
Bank Name: ____________________________________________
Bank Account #: ____________________________________________
Bank Routing #: ____________________________________________
*Or send a voided check to the MinKwon Center attached to this form.
Authorization
I (we) hereby authorize the MinKwon Center to initiate either credit card or bank account transaction(s) in an amount only as authorized on this form.
Recipient Name: MinKwon Center for Community Action
Tax ID #: 11-2710506
Signature: ___________________________ Date: ___________________________