House of Hope - Illinois Credit Card Donation Authorization Form
We thank you for your gift. Together we can change lives and offer local hurting teens hope and a future.
I (print name),____________________________________, do hereby authorize House of Hope - Illinois to charge
$__________, a one time donation to my Visa / Master Card (circle one).
OR
$__________, per month to my Visa / Master Card (circle one).
My credit card account number is____________________________and the expiration date is ____/____.
I acknowledge that these debits are charitable gifts, and I will receive no goods or services from House of Hope - Illinois. This authorization shall be effective until I notify House of Hope - Illinois in writing to stop this monthly debit to my credit card. Such notice must be sent by letter, mailed to P.O. Box 281, Mokena, IL 60448.
PERSONAL INFORMATION AS IT APPEARS ON MY CREDIT CARD:
All information is required, PLEASE PRINT
Name: ___________________________________________________
Address: _________________________________________________
City/State/Zip: _____________________________________________
Phone: (________)__________________________________________
Signature: _________________________________________________ Date: ________________________
This gift is:
IN HONOR OF: ____________________________________________
IN MEMORY OF: ___________________________________________
House of Hope - Illinois will send a personalized card acknowledging your thoughtful gift in Honor Of or in Memory Of to your person of choice. Please tell us the name and address for the personalized card.
Name: ___________________________________________________
Address: _________________________________________________
City/State/Zip: _____________________________________________
Please mail completed form to P.O. Box 401, Frankfort, IL 60423.
All credit card charges will be posted on the 20th of the month immediately following receipt of this authorization form. Monthly charge will cease on the 20th of the month immediately following the receipt of notice canceling this authorization form.
Thank you for your gift to help hurting teens and families.