People or Project name and number (Ex. #710 - Where Most Needed)

Amount of Gift (Ex. $1000.00)

Monthly or Single Gift Monthly or Single Gift Single donation Monthly donation

If monthly gift, what is the start date?

If monthly gift, what day of the month?

Bank Name

Routing Number (9-digits, lower left of check)

Account Number (to the right of routing number)

First and Last Name

Email Address

Telephone

Street

City

State

Zip Code

Comments (not required)