EarthLight Magazine

Empowering individuals and faith communities to live and work in touch with the Earth

PRINT AND MAIL(or fax) DONATION FORM
Please press the PRINT button on your browser to print this form.
Then fill out the paper form and mail or fax it with your check,
money order or credit card info (as appropriate) to:

EarthLight  Magazine  --  111 Fairmount Avenue  --  Oakland, CA 94611, USA

 (PLEASE PRINT)

Name:

 

Address Line 1:

 

Address Line 2:

 

City, State & Zip:

 

Country:

 

Telephone:

 

E-Mail Address:

 

(Your e-mail address will help us save time and postage on confirmations & correspondence.)

 

CONTRIBUTION of any amount (special thanks for your support)

$

EarthSaints Special Issue $6    Back Issue #____$6    Back Issue #____$6

$
TOTAL

$

THANK YOU FOR YOUR DONATION.  HERE ARE OUR
MAIL & FAX PAYMENT OPTIONS (Please check the one you want to use):

Please pay by check whenever possible.  Your payment by check makes an extra contribution to EarthLight (it helps us save on credit card processing fees and bookkeeping expenses).

1.  [___]  PAY BY CHECK:  Make a check (or money order) payable to "EarthLight" and mail with all pages of this form (filled out down to here) to the address shown above.  

2.  [___]  CREDIT CARD by MAIL: If you want to pay by credit card, fill in your credit card information in the section below, SIGN FORM and mail all pages of this form to the address shown above.

3.  [___]  CREDIT CARD by FAX: If you want to pay by credit card, fill in your credit card information below, SIGN FORM and FAX all pages of this form to 510-451-3505.

PRIVACY: Earthlight hopes to increase its subscription list. To do this we may agree to trade names with similarly oriented groups. To request that your name NOT be exchanged check here:  [___].

Credit Card Information for our processing service:

 Name on card....:__________________________________

 Type of card..:[___]MasterCard     [___]Visa

 Card Number.....:_________________________________

 Expiration Date :  [____] Month  /  [____]Year 

If billing address or telephone number of the credit card holder is different from subscription mailing address and phone# entered above, please enter the cardholder's information below.  (Thanks for giving us all the info we need to process your credit card charge.)

 Cardholder's Name..:

 Cardholder's Phone#:

 Address Line 1.....:

 Address Line 2.....:

 City, State & Zip..:

 Country............:

YOUR SIGNATURE AND DATE
I authorize EarthLight Magazine to submit my donation to the ECHO Credit Card Processing Service. (Please note: The charge for the total amout on this order form will appear on your credit card statement as a charge to "EarthLight Mag")



________________________________
 Signature                          



__________________
              Date