2015-no logo.jpg

 

 SERVING HOPE MONTHLY CLUB

        MONTHLY DONOR FORM

               

YOUR CONTACT INFORMATION

Date: __________________     *Person Taking Donation: ______________________________

Title.: __________        *First and Last name:        ________________________________________

*Address:                      ____________________________________________________________

*City, State and Zip:        ____________________________________________________________

*Email address:                     __________________________________________*Phone#:   ____________________________


*DONATION AMOUNT:  $______________________PER MONTH

*PAYMENT METHOD CREDIT CARD ________        CHECK________(Make payable to Lunch Break)

For credit card donations: The best way to make your monthly donation is through our website.  Please log on to www.lunchbreak.org and click on the Donate Now button. Click on or enter the amount you would like to donate and below that, please select “Monthly.”  You will provide your own username and password which will allow you to edit your payment any time.  Only you will have access to your account.  You will receive via email a receipt each time your card is charged.

*YOUR CREDIT CARD INFORMATION (if you would like us to process your card each month.)

Credit Card Type:        __ American Express                ___MasterCard                ___Visa

Credit Card Number:____________________________    Exp Date:______________  Sec. Code: _____

____        Donate 100%         Add 3% so that 100% of the donation goes to LUNCH BREAK

_________ Date each month donation processed

*ACKNOWLEDGEMENT:

Does your company offer a MATCHING GIFT program?

If YES, please provide your company name. __________________________________________


1 Copy for Development Department File

FORM MUST ALSO BE GIVEN TO THE FINANCE DEPARTMENT TO PROCESS DONATION(s)

*Required information

121 Drs. James Parker Boulevard, Red Bank, NJ  07701

Telephone: (732)747-8577 * Fax (732) 383 8032

www.lunchbreak.org