Recurring Donation Plan Form
Please Print the from below and mail to Love a Golden Rescue
Name __________________________________________
Address ________________________________________
City/State/Zip ____________________________________
Phone: _________________________________________
E-Mail __________________________________________
RECURRING amount to be donated EACH MONTH:
__________________________________________
By signing below I authorize use of my credit card for
donations to Love A Golden Rescue (LAGR) MONTHLY in the amount
indicated above. I understand that this authorization will
remain in effect until I notify LAGR in writing of any change.
Credit Card Type (Visa/MasterCard) _____________________
Credit Card Number _________________________________
Credit Card Expiration Date __________________________
Authorized Signature _____________________________
Date ____________________________
Return to:
Love A Golden Rescue
P.O. Box 27621
St. Louis MO 63146-0621
Recurring Donation Terms: Your Recurring Donor
Subscription will automatically renew until you cancel your subscription.
You may cancel your subscription to the Recurring Donor Plan for Love a
Golden Rescue through your PayPal Account. See PayPal
for more details.
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