Vision 20/20 Commitment Form

Total Commitment*

My enclosed gift today:*

In addition to the gift enclosed, I will commit to give the following amount over the next 15 months:*

My monthly gift over the next 15 months will be given by credit card*

Amount:

*

Monthly option will divide commitment evenly of 15 months Semi-monthly options will divide monthly commitment into two payments

Name as it appears on Card*

First Last

Credit Card Number*

Credit Card Expiration Date*

Credit Card CVV Number*

Credit Card Full Billing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email*

Cell Phone*