GIVE HOPE PHONE FORM

Contact Info

PLEASE ASK HOW TO SPELL THEIR NAME; VERY IMPORTANT TO RUN CARDS

Full Name *

Did you mean @?

First and Last, Please

Mailing Address *

Did you mean @?

City / Town *

Did you mean @?

State *

Did you mean @?

Zip Code *

Did you mean @?

Phone Number *

Did you mean @?

Just in case we need to call them back

Email Address

Did you mean @?

Not required, but if they want to give it for Receipts etc.

First Questions

DONATION AMOUNT *

Did you mean @?

$

Are you a First Timer Giver to KJIL/KHYM

Giving By Credit Card

IF THEY WANT TO GIVE BY ACH, THAT FORM IS FURTHER BELOW

CREDIT CARD NUMBER

Did you mean @?

Expiration Date

Did you mean @?

Sec. Code

Did you mean @?

Three Digit Code on the Back

Start Date

Did you mean @?

Would they like to start today or different date in the month

When Would You Like Receipts

DONATION USING ACH (BANK DRAFT)

ACH Routing #

Did you mean @?

Account #

Did you mean @?

Team 360 Shirt Size

For people giving $30 or more a month, or onetime gift of $360 or more

Shirt Size (adult sizes)

STORY OR COMMENT

This is only if you have time; the storyline is 620-873-7341 if they would like to leave a voicemail.

Story (or Comment or Prayer)

This can be left alone: