My first monthly gift is enclosed for:
__ $25 __ $20 __ $15 __ Other $ ______
Please choose one of the following payment options:
__ Checking account electronic transfer. Please transfer $_____
each month from my checking account for the next 14 months. (Remember
to enclose your first payment on a personal check.)
__ Credit card. Please charge $______ to my credit card each month for the next 14 months. My credit card information is below.
__ I can't make a montly pledge at this time. Enclosed is my one-time
contribution to help launch this exciting campaign:
__ $25 __ $35 __ $75 __ Other $ _______
__Check enclosed ___ One-time charge to credit card below.
|PLEDGE AUTHORIZATION (required for monthly contributors)
I authorize NOW/PAC to transfer my monthly contribution from my checking account or to charge my credit card (whichever I have chosen above). I understand I may cancel or change my monthly pledge at any time by notifying NOW/PAC. A record of each payment will appear on my monthly bank or credit card statement and will serve as my receipt.
Date: _______________ Signature: ____________________________________________________
Credit card information: __ Visa __ Mastercard __ American Express
Card number: _____________________________________ Exp. Date: ______________
Please print name as it appears on card: ________________________________________________________
Mail to: NOW/PAC 733 15st, NW, 2nd Floor, Washington, D.C. 20005
NOTE: Contributions to the NOW/PAC are not tax-deductible. Only NOW members may contribute to NOW/PAC. Federal law requires NOW to use our best effort to collect and report the name, mailing address, occupation and employer of contributors who exceed $200 in a calendar year.