White copy: fold and place in envelope

Yellow copy: for your records

1. WHAT TOUCHED YOU THE MOST TONIGHT?

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

2. MY TOTAL GIFT 3. 120 Team Member

□ Contributor ($25-299)
$ __________________.00 □ Partner Level #1 ($300-1,999)
□ Partner Level 2 ($2,000-11,999)
□ Partner Level #3 ($12,000 and up)
4. MY PERSONAL INFORMATION (Please print firmly)
Name ___________________________________________________________________________________
Address _________________________________________________________________________________
City_____________________________________________ State _______________ Zip ________________
E-mail _____________________________________________ Phone (_____) ________________________
Home Church ____________________________________________________________________________

5. TONIGHT’S GIFT ( I’m giving a portion of my total gift – see #2 above)

$ _________.00
□ CHECK (enclosed) □ CASH (enclosed) □ CREDIT/DEBIT (please fill in card info below)
Credit Card Number ______________________________________ Expiration Date _______/________
Signature _______________________________________________________ CCV__________________

6. PLEDGE (After tonight, I’m giving the balance of my total gift – see #2 above)

$ _________.00

□ Monthly Partnership Program □ Quarterly □ Once

□ Mail (I’ll mail my pledge to First Choice)

□ Website (I’ll go to website and fulfill my pledge: www.1stChoiceFriends.org)

□ Electronic Funds Transfer* (Starting on the first of next month, automatically withdraw my next gift)
* Please include voided check or we will call for details

□ Credit/Debit (Starting on the first of next month, automatically deduct my next gift)

Credit Card Number ______________________________________ Expiration Date _______/________

Signature _______________________________________________________ CCV__________________