Contribution/Pledge Form

Give Online | Pledge Online | Planned Giving | Gifts of Securities | Automated Credit Card Donations | For Canadian Contributors

You can make a contribution to the CLF by using our secure online form or you can print and complete this form and fax it to 617-523-4123 or mail to CLF, 25 Beacon Street, Boston MA 02108.

Enclosed is a Contribution of $ _______________ To be applied to:           My/Our 2008 Pledge (Jan-Dec '07) is $_______________   Prison Ministry   Other: ______________________________

Name: _____________________________________________

Address: ____________________________________________________________

City: ______________________________ State/Prov: ______ Zip: _______________

Country: ______________________________

Daytime Phone: _________________________ Email Address: _________________________

Method of Payment:

Check payable to CLF enclosed   VISA  MasterCard  Discover

Credit card number: _________________________________   Exp. date: _____________

Signature: ___________________________________

Billing Address (if different from above): _________________________________________________

Billing City: ______________________________ Billing State/Prov: ______ Billing Zip: ___________

Billing Country: ______________________________

Automatic Credit Card Donations: If you wish to set up automatic credit card donations, please complete the following. Please note that this charge will continue at this amount until such time as you notify CLF that you wish to modify or discontinue.

Please deduct (amount): ______________ from my credit card.

monthly   quarterly   annually, in (month): ______________