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General Donation (SECURE FORM)

* Indicates required field

*First Name:

*Last Name:

*Address 1:

Address 2:

*City:

*State:

*Zip:

Phone:

*E-mail:

*DonationAmount:



I would like to join the Sharing the Light Club.

X

months

 =

I will send my monthly contribution by mail.  Please send me a coupon book.
Please bill my credit card each month. (To be billed the 15th of each month)
Please send me information for electronic funds transfer.

Memorial or Honorary Gifts

This gift is in memory of:

First Name:
Last Name:

Please notify:
First Name:
Last Name:
Address:
City:
State:
Zip:

This gift is in honor of:

First Name:
Last Name:
Address:
City:
State:
Zip:

Credit Card information

Card Type:
Cardholder's Name:
Card Number:
Expiration:

Please bill my credit card each month for the amount indicated above.


Preferred form of contact:








City Rescue Mission • 800 W. California Ave. • Oklahoma City, OK 73106 •  (405) 232-2709