June 2017 Summer Solstice Sustaining Donor Drive

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If you would like to enjoy the convenience of automatic recurring billing, simply complete the Credit Card Information section below and sign the form. All requested information is required. Upon approval, we will automatically bill your credit card for the amount indicated and your total charges will appear on your monthly credit card statement.

You may cancel this automatic billing authorization at any time by contacting rose@revelsnorth.org or calling 866-556-3083.

Thank you for helping us meet our Mid Year Appeal goal.
All information submitted will remain confidential.

First Name *

Last Name *

Street *

Town *

State *

Zip Code *

Phone *

Email Address *

Monthly Donation Amount *

$10

$15

$20

$25

$30

$40

$50

$75

$100

$150

$250

$500

$1000

Other:

Is this gift to be anonymous? *

Yes

Is this gift in memory of David Gay? *

Yes

Credit Card Type *

All account information will be kept private.

Credit Card Number *

All account information will be kept private.

Credit Card Expiration *

Credit Card CVV# *

3 numbers on the back of your card

Submit

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