Archdiocesan Annual Appeal 2006 Gift Form

Please prayerfully consider your gift
Con mucha oracion, por favor, considere su donacion
If you want to make a gift over time, consider the following:
Si desea hacer una donacion sobre tiempo, considere lo siguiente:

10 Monthly payments of:
10 Pagos mensuales de:
    Equals a total gift of:
     Donacion total sera:
$ 15               $ 150
$ 20               $ 200
$ 25               $ 250
$ 35               $ 350
$ 50               $ 500
$ 75               $ 750
$100              $1000
$250              $2500

Please Print Clearly (For favor escriba claramente):

Mr. and/or Mrs. (Sr. y/o Sra.)
Ms., Rev., Dr.: (Senorita o Dr.)___________________________________________

Spouse (Esposa (o)):___________________________________________________

Billing Address (Direccion):______________________________________________

City/State/Zip (Ciudad/Estado/Codigo postal):________________________________

Phone Number (Telefono): _____________ Day Time Phone Number:_____________

E-Mail Address: _______________________________

Parish (Parroquia):_____________________________________________________

Is this a new address within the past year? ___Yes ___No

ifista fue su direccion el ano pasado? ___ Si ___ No

Sienature (Su firmal):___________________________________________________

Please indicate payment Schedule:
Voy a pagar lo que me resta de la siguiente manera:

__ 10 Pmts. Pagos March-December (marzo - diciembre)

__ 4 Pmts. Pagos April-July-Oct-Dec (abril-juio-oct-dic)

__ 2 Pmts. Pagos April and October (abril y octubre)

__ 1 Pmt. Pago Please indicate Month ________ (Por favor indique el mes) ______

__ Electronic Funds Transfer

__ Credit Card

My Total Contribution is (Mi contribucion este ano es de) $ _______

Amount Paying Today (Estoy dando hoy) $ ________

Balance (Mi balance es de) $ _______

Make checks payable to ADF
Haga los cheques a nombre del ADF

Does your company have a "matching gift" program? __Yes __No

Electronic Funds Transfer (Void check must be attached)
Please have $ _______ automatically deducted from my checking account for ____ months (Last month being December 2006) until my pledge is paid in full. Deductions will be made on the 15th of each month beginning March 15, 2006 and ending December 15, 2006.

Name of Bank_______________________________ Account # _______________

Signature___________________________________ Date___________________

Credit Card Information

Please charge my 2006 ADF gift of $ ______ to my __ Master Card __ Visa

Account # ___________________________ Exp. Date __ / __

Card Holders Name _______________________________________

I understand that my credit card will be charged ONE time for the TOTAL amount of my gift.