The data you enter on this form will be submitted to my personal web-server and delivered to me within 24 hours.
You have many options for donating. Your payment can be made in the form of Check, Credit Card, or Checking Account Automatic Monthly Debiting (see below). And, remember, a donation $200 or more, entitles you to one of my California AIDS Ride 7 Portfolios.
Your pledge can be made in a lump sum, or donated in monthly payments spread over time. You choose the number of months and the donation each month. The only limitations are (1) your monthly contribution must be greater than $25, and (2) your contributions cannot extend beyond 10 months (3) you must choose either Checking Account Automatic Monthly Debiting or Credit Card as your payment option. For example, you could donate $100 by making 4 payments of $25 each. Or, you could take home a portfolio for 5 monthly payments of $40 each; $200 total.
Let me know if you would like more information about these payment options in the "Comments" section below. I will respond to you by your preferred method (phone, e-mail, or US Mail) within a day. If requesting a photo portfolio, please allow 10-14 days for handling and delivery via USPS Priority Mail.
Thanks
Last Name: First: MI:
Mailing Address: Apt/Suite:
City: State: Zip:
Heroism....................................... $750 Paid in Full 10 monthly payments of $75
Inspiration.................................. $500 Paid in Full 10 monthly payments of $50
Spirit........................................... $150 Paid in Full 6 monthly payments of $25
Other Amount............................. $??? Single Payment in Full (amount $) monthly payments of $ (monthly payments must be $25 or higher and cannot extend beyond 10 months)
Personal Check - Single Payment in Full If you are making a full single payment, please make checks payable to California AIDS Ride. (please include rider name Ben Mui and rider number 5823 on all checks.)
Checking Account Automatic Monthly Debiting If you wish to have your pledge debited automatically each month from your checking account, please read the following very carefully. You will need to complete a section a the pledge form which I will send to you. You will also need to attach a VOIDED blank check to the form (not a deposit slip). NOTE: You may only use this option if your monthl payment will be $25 or more. IMPORTANT: Your monthly statement(s) will read L.A.G.L.C.S.C. Please read and complete the following. I (we) hereby authorize the Los Angeles Gay & Lesbian Center to initiate debit entried and to initiate, if ncessary, credit entries and adjustments for any debit entries in error to my (our) account, upon processing of the form by the pledge office. This authority is to remain in full force and effect until my pledge is fulfilled or until revoked by me (us) in writing. Payments commence immediately upon processing of this form by the Pledge Office. Pledges are tax deductible to the fullest extent of the law.
Pledging by Credit Card You may select one of the following cards: Visa, MasterCard, American Express. IMPORTANT: Your monthly statements(s) will read L.A.G.L.C.S.C. Please read and complete the following. Payments commence immediately upon processing of this form by the Pledge Office. Pledges are tax deductible to the fullest extent of the law. Pledges are non-refundable.
Comments for Ben:
