Monthly Credit/Debit Card Program
 Foundation of Human Understanding • PO Box 1000, Grants Pass, OR 97528
FAX 1-541-956-6705 • E-MAIL [email protected]

You may call us 1-800-877-3227, 9-5pm Pacific Time to place your pledge or
print out the form below and mail or fax it to the FHU.

2 Easy Steps:
1. Complete the form below and then print.
2. Sign and date it.
3. Return the form to FHU at the address above.

I wish to make an automatic monthly pledge of...
$200     $100     $75     $50     $25     $10  
other (enter amount)

...to be placed on my credit/debit card on the (date)_______ of every month.

Name:
Address:
City:
State
Zip Code:
Telephone:


How do you listen to Roy?
Radio Station (Enter station call letters)
Web Site
Both
None


Credit Card type: Visa     Mastercard     Discover
Credit/Debit Card # - - -

Exp. Date (Mo/Yr)

Card verification #
(The card verification number is found on the back of your card where you sign your name.
There are a series of small, printed numbers. Enter last 3 numbers).


Signed..............................................................   Date: