SC Autism Society - Expansion Campaign

SC Autism Society Expansion Campaign

* First Name :	(include middle initial if you like)
* Last Name:	(include name suffix if you like)
* Address 1	(For credit cards, this should match your billing address.)
Address 2
* City	* State * Zip Code
* Phone	Please include area code.
* E-mail	(Your privacy is respected at SCAS.)
* Name on Credit Card :	(If different than above)
Authorized Signature (if printing):
Authorized Date
In Honor of:	(optional)
In Memory of:	(optional)

Yes, I/We wish to make a gift to the Campaign in the amount of:

$50,000

$25,000

$20,000

$15,000

$10,000

Indicate "Other" amount.
$

$ 7,500

$ 5,000

$ 3,000

$ 2,500

$ 1,500

$ 1,000

$ 750

$ 500

$ 250

Other:

Contribution Schedule: (A member of the SCAS staff will contact you regarding scheduled contributions.)

One-Time

Monthly

Quarterly

Yearly

Other:

Indicate "Other" schedule.

Contribution Method:

Charge to:	Visa	MC	Discover	I prefer to pay in stock.
I will mail a check. Mailing address is below. Please include a printed copy of this form with your check to ensure proper processing. Please make your check payable to SCAS Expansion Campaign.


	*Once you submit this form, a credit card form will be displayed via Authorize.Net.

Please remember South Carolina Autism Society as you plan your estate and will.