Monetary Donation Form

Please print and complete this form and mail it with your donation. Thank you.

Crisis Pregnancy Support Center of the Mainland, Inc.
“Provides support services for women experiencing unplanned pregnancies.”


Name:

Address: 

City, State, Zip:

Phone: 

Email: 

 

Thank you for supporting the ministry
 Crisis Pregnancy Support Center of the Mainland, Inc. is a 501(c)(3) corporation.  Tax-deductible receipts are issued for all gifts

COMMITMENT

– Monthly    – One Time    – Other: ________________________     $ ____________

CASH DONATION

Mail to:    CRISIS PREGNANCY SUPPORT CENTER
:              P.O. BOX 164
               TEXAS CITY, TX  77592-0164

CHARGE DONATION

For Your Convenience
Bill Account Is:  (  ) Visa    (  ) MasterCard    (  ) American Express

_____________________________________________________________
Card Number                                                                               Exp Date

_____________________________________________________________
Printed Name

_____________________________________________________________
Cardholder’s Signature: This is required to validate your credit card payment)

 

HONORARIUM or MEMORIAL GIFT

–   A memorial donation is being made in the amount of  $

The gift is honor of:  _________________________________________
                                                   (Name)
     The relationship is    _________________________________________

(friend, mother, etc)

 

The person to be notified of my gift:

Name:

Address: 

City, State, Zip: