Mail-in Credit Card Donation

Please print this page and mail to:

Kerry Blue Terrier Foundation
P.O. Box 1495
Solvang, CA 93464
USA

 

Dear Kerry Foundation,

• Please charge my credit card in the amount of US$ ________.
  
• You are authorized to charge this amount to my account:
  ___ every month, ____ every quarter, ____ every year, ____ only once.
  
• My crecit card is a
  ____ Visa, ____ MasterCard, ____ Discover, ___ American Express.
  Account number: _____________________________ Exp. Date: _______
  Signature: ____________________________
  
• I want my contribution to be used for:
  ____ Education, ____ Rescue, ____ Health & Genetics Research,
  ____ Endowment, _____ Where it is most needed.
  
• ____ My employer will match my gift.
  Employer: _____________________________________________
  Matching gift forms are : ____ Enclosed, _____ Forthcoming.
  
• ____ I authorize the Foundation to list my name as a donor on the Foundation web site.
  
• ____ I have included the Foundation in my Will or Estate Plans.
  

Please send me a receipt for tax purposes.

Name: _____________________

Address:____________________

City: _________________________ State: _______ Zip: ________

Last Update: 08/30/06, 00:12:47  Terms of Use and Disclaimer.