Annual Membership Pledge
Fiscal Year 2008
/2009
July 2008
- June 2009
NAME
PHONE NUMBER
ADDRESS
EMAIL ADDRESS
Step 1 – Designate your Annual Pledge for This Year
Please review the Temple Emanu-El Fair Share Membership Policy
This year’s (July 2008
/June2009
) Membership Pledge:
Step 2 – Pick a Payment Method
Please pick ONE Method Payment
(Click in Box)
Annually
I am enclosing a check for the full amount, or authorizing a credit
card charge for the full amount
Quarterly
Credit Card
I am authorizing a credit card charge to automatically be charged
each quarter for the next four quarters, through June 200
9
Monthly
Only available to those paying by credit card.
(I am authorizing
a credit card charge to automatically be charged each month
through June 200
9
)
Quarterly
Billing
Bill me on a quarterly basis
Step 3 – Credit Card Authorization
(If applicable)
PLEASE NOTE:
Even if you have previously authorized charging your credit card for any
use at Temple Emanu-El, you must provide current credit card information and authorization.
Name of Credit Card Holder:
Credit Card (CHECK ONE)
VISA
MASTER CARD
Credit Card Number:
CVV Number (3-digit number on back of card
Credit Card Expiration Date:
Step 4 – Authorization and Submission
(PLEASE NOTE: By submitting this form you are
authorizing the pledge and payment)
To complete your Annual Pledge and Authorization for Payment, please click the
Submit Button (See Below).
