Monthly Donation setup form

CALIFORNIA SHERPA ASSOCIATION

Future Community Center Building Donation Please Set up your online Monthly Donation your small contribution will Help all of us to make our dream come true

Your Name

First

Middle

Last

your Address

Address Line 1

Address Line 2

City

State

Zip Code

Your Phone Number

Your Email

Email

Confirm Email

Please Choose your Monthly Donation from Drop down box

Thank you so much for choosing your automatic monthly Donation

Payment you want to set up monthly

$0.00

Today's Date

please Inter Today's Date.

Your Comment or Message

This is Optional only write if you want to say something.

pay with Your Credit card

Card

Name on Card

Payment will be automatically deducted on a monthly basis.

Your Signature

I understand and agree to these terms.

I agree.

checking the box, I agree that my credit card will be charged monthly in the amount I enter here and that I am responsible for all payments. Payments will continue until I end the agreement.

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CALIFORNIA SHERPA ASSOCIATION

Author: Kami Sherpa