Credit Card Forms

______________________________________________________
Name:
______________________________________________________
Billing Address 1:
______________________________________________________
Address 2:
______________________________________________________
City/State Zip:
______________________________________________________
Phone Number:
______________________________________________________
Type of Credit Card:
______________________________________________________
Credit Card Number:
______________________________________________________
Expiration Date:
______________________________________________________
Amount of Donation:
______________________________________________________


If gift is in honor of an individual, please list name of honoree and indicate type of gift.

Name of honoree: _____________________________________
□ In Honor of
□ In Memory of
□ On the Occasion of _________________
Please specify occasion

Please send notification of this gift to (optional):
Name: __________________________________________
Address: ________________________________________
City/State/Zip: ___________________________________



□ Check this box if you would like someone to contact you regarding this gift or to set-up a reoccurring gift.

Please fill out and return this form and your tax deductible donation to:

THE CANCER LEAGUE, INC.,
6114 La Salle Avenue, P.M.B. 534, Oakland, CA 94611-2802

The Cancer League, Inc. is a non-profit public benefit corporation – a 501c(3) organization. TIN Number 94-3198168