Mary Jane Clark Giving Circle

Mary Jane Clark Giving Circle

Recurring Gift Pledge and Payment Collection Form
Invited by:
If a disABILITYsa board member, staff, or volunteer encouraged your recurring gift, please let us know.
Full Name (Two Fields) *

First Name Last Name
Email *
example@example.com
Cell Phone Number *
Please enter a valid phone number.
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Payment Preference *

Check: I will schedule Bill Pay through my bank (There are no processing fees associated with checks, so 100% of your contribution will support the mission of disABILITYsa) Facebook Payments (Facebook covers all processing fees and 100% of your donation supports the mission of disABILITYsa) Credit Card: (Square will deduct a processing fee of 3.9%+$.15)
Donation Pledge Amount: *
Suggested Donation: $25+/month | $150+/semi-annual | $300+/annual
Payment Frequency *

Monthly Semi-Annual (once every 6 months) Annual

Credit Card Donation Options and Payment Information *

Monthly Donation Suggested donation of $25+ or more every month.

USD for each month

Bi-Annual Donation Suggested donation of $150+ or more every 6 months.

USD for each six months

Annual Donation Suggested donation of $300+ or more every 12 months.

USD for each year

Donors receive an email when your card is charged successfully. You can cancel your recurring gift at any time via this email. For additional assistance, please contact us at accounting@disabilitysa.org.
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