DONOR AUTHORIZATION FOR EFI TO MAKE
MONTHLY CHARGES TO DONOR CREDIT CARD


I ____________________________________, (please print cardholder name) herewith give my permission to
and so authorize the Environic Foundation International to post monthly charges to my:


___Visa ___MasterCard ___American Express

___ Discover ___ Diners Club credit card


My credit card number is: _________________________________________________

My credit card expiration date is: ______ Month ______ Year



I understand that the Foundation is a registered 501 (c)(3) corporation and that my donations are tax-
deductible under the Internal Revenue Code of the United States.

I authorize EFI to charge my account $ _____________ monthly.


Signature: _______________________________________________________
(cardholder signature required)


It is most convenient for EFI to contact me via

E-mail: ____________________________

Telephone: ________________________


My credit card billing address is:

________________________________________________


Street ________________________________________________


City/Town ________________________________________________


State/Province _____________________________________________


Postal / ZIP Code ___________________________


Country ________________________________




Please mail or fax this completed form to:

Environic Foundation International
12035 Stonewick Place
Glen Allen, MD 23059-7152
USA

Fax: 804-360-9131