Recurring Donations

Donor Name:
Address:
City: State: Zip:
Email Address:
Home Phone:
Yes! I pledge to support the:
$100.00 per year for the next 3 / 5 years. $75.00 per year for the next 3 / 5 years.
$50.00 per year for the next 3 / 5 years. $25.00 per year for the next 3 / 5 years.
(Please check a dollar amount box and circle the number of years.)
I have enclosed a check for this year. Please send me a reminder every year in the month of to fullfill my pledge.
Please charge my credit card /EFT for this year's pledge amount and in each of the remaining years in the future until my pledge is fullfilled.
Please charge my EFT /credit card $ each month for the next 3 /5 years until further notice from me.
($20.00 minimum on recurring monthly credit card donation)
Credit Card:Card Number:
Address on Card:
City: State: Zip:
Card Type:
Visa
MasterCard
American Express
Discover
Electronic Funds Transfer: Acct #
Transit / ABA #:  Checking __ Savings __
Deduction Dates Available: ____1st    ___10th    ___20th
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

Use my donation to support_____________________________ program.

 

Signature: ______________________________Date:___________
Please Print and send this form and your donation to:
The Delta Chi Educational Foundation
P.O. Box 383
Columbus, IN 47202