DONATIONS (Please print and fax completed form to 281-657-7588) Gifts to Gospel Lakes can be made by check or even setup as an automatic monthly charge to your credit card to keep things simple. If you would like to help out, just send your first donation to Gospel Lakes, P.O. Box 67, New Waverly, Texas, 77358-0067 along with this form. Or, simply fill out your credit card information and we'll set you up on an automatic monthly gift. Gifts to Gospel Lakes qualify as a tax deductible charitable contribution.___ Please accept my special gift to Gospel Lakes in the amount of $_________ ___ Please accept my first monthly gift to Gospel Lakes in the amount of $_________ ___ Please send me remittance envelopes for future monthly gifts. Name (s): ________________________________ Phone: ___________________ Address: ________________________________ Email: ___________________ City: _____________ ST: ___ Zip: ________ ___ Please set me up on an automatic monthly gift: Credit Card Automatic Draft Form I (We) hereby authorize Gospel Lakes Ministries, Inc. to initiate charges to my (our): O Visa O MasterCard O American Express O Discover Account # __________________________________ Exp. Date: ________________ __ $5 per month (charged quarterly) __ $10 per month (charged quarterly) __ $25 per month __ $50 per month __ $75 per month __ $100 per month __ $200 per month __ $500 per month __ $1000 per month __ $_______ per month Name (s): ________________________________ Phone: ___________________ Address: ________________________________ Email: ___________________ City: _____________ ST: __ Zip: ________ This authorization will remain in full force and effect until Gospel Lakes Ministries receives written notification from me (or either of us). Signature: ____________________________ Date: _____________ Signature: ____________________________ Date: _____________
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