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June 2017 Summer Solstice Sustaining Donor Drive
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
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Last Name
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Street
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Town
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State
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Zip Code
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Phone
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Email Address
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Monthly Donation Amount
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Is this gift in memory of David Gay?
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Credit Card Number
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Credit Card Expiration
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