Project Connect Sponsor

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Sponsor Amount:  $ (e.g. 180.00)

Customer Billing Information
  First Name:
  Last Name:
  Company Name:
  Address:
  City:
  State/Prov:
  Zip Code:
  Country:
  Phone Number:
  Email Address:


Payment Details
  Card Type:
  Card Number:
  Exp. Month:
  Exp. Year:  
  Security Code:
This is the 3 or 4 digit number printed on the back signature panel.
It is on the front of the card for American Express.


Optional Details
  How Did You Hear About Us?
  Additional Comments:
 
Please mail a receipt to the address above (in addition to the receipt I will receive via email).


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American Friends of Meir Panim is a registered 501(c)(3) non-profit organization, registered under EIN # 20-1582478.
Donations to American Friends of Meir Panim are tax deductible in the USA.
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