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Donate Now – DeFrank Center Mail-in Form
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A
United Way Agency Nonprofit Tax ID#94-2850498
INSTRUCTIONS: Print this form and mail with your
donation of support to:
Membership
Billy DeFrank Center
938 The Alameda
San Jose, CA 95126
Name(s):
__________________________________ and
____________________________
Billing Address:_______________________________________
Billing Address:_______________________________________
City, State,
Zip:_____________________________________________________
Phone (daytime) ____________________________
Phone (evening) ____________________________
Email Address:
______________________@_____________________
Please call me:
_____ during the day between 10:00am and
4:00pm
_____ during the evening, between 6:00pm and 8:00pm
_____ only during the weekend at my ___ daytime ____
evening phone number
I am
____ Making a General Donation (use where it is needed most)
____ Making a Building fund Donation
____ Joining/Renewing membership
I am making a donation in Memory of: ____________________________
I am making a donation in the Name of: ____________________________
If you would like us to send a letter to the person you are making the donation for, please type their contact information here:
Gift Recipient's Address:_______________________________________
City, State, Zip:_____________________________________________________
Currently a DeFrank Center member? ____ No ____ Yes, my Membership Number: ______________
I would like to pledge/contribute the amount of $____________.
I would like this to be a ____ one time contribution ____ monthly contribution.
I would like to submit my pledge/contribution by:
____ Credit Card: ___ VISA ___ Mastecard ___ Discover ___ American Express
Number
________________________________________ expiration
date ___________________
Name on card (if different than above)
_____________________________________________
Billing address (if different than above)
_____________________________________________
Signature
_____________________________________________
____ Check enclosed
Please check one. Credit Card deduction made on the same day each month:
1st ______
10th _____
15th _____
20th _____
30/31st _____
If any of these days falls on a Saturday, Sunday or bank
holiday the charge will be made on
the next business day.
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