Thank You!

Contribution Amount:

	SIMPLE GIFT	MONTHLY GIFT	All contributions are tax-deductible. Please choose either the Simple Gift or the Monthly Gift plan. Free-will donations of any size or frequency are also appreciated. Please check one option
Check the	__ $30	How Much would you like to contribute each month?
item you	__ $50
want	__ $100	__ $10/mo
		__ $30/mo

You Name It	__ $_________	___ $__________ /mo

Contribution Method: ("Check" the one below you prefer)

__ Check
__ Money Order

Check / Money Order Info: Make check or money order payable to: Coffee with Paul Ministries.
On the "For" line please write: Coffee with Paul

__ Discover
__ Master Card
__ Visa

Credit Card Info

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Credit Card Expiration Date

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Credit Card #

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Signature

__ Automatic Withdrawal

*For this option only, please include a copy of a voided check or cancelled check along with this current page.

Automatic Withdrawal Info: Choose Date: ___5th ___20th

_________________________________________________
Routing Number from check

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Account Number from check

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Name of Bank

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Bank Address

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Your Signature

Your Name:____________________________________________ Email: ______________________________________

Mailing Address: _________________________________________________________________Zip________________

Please send this form with your contribution or cancelled check to:

Coffee with Paul Ministries/ Gary D. Collier, Director /
452 West Water Street / Cloverdale, IN 46120

For questions call: 317.536.8162

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