Donations Credit Card Form

Thank you for considering the Janice Mitchell Isbell Academy Inc. worthy to receive your donation. Please complete the information below. You will help educate a young person.

Please charge my credit card with my Donation to the JANICE MITCHELL ISBELL ACADEMY, INC.

Please complete and return this form to JMIA, P O BOX 17425, HUNTSVILLE AL 35810 or EMAIL FORM to isbell_academy@yahoo.com or FAX 1-256-858-3046.

Name____________________________________________________________________________________

Address__________________________________________________________________________________

City/State/Zip Code________________________________________________________________________

Country__________________________________________________________________________________

Telephone Numbers (H/C/W)_________________________________________________________________

Email____________________________________________________________________________________

Credit Card Type (VISA/MC/AMEX/DC)________________________________________________________

Card Number______________________________________________________________________________

Expiry Date_______________________________________________________________________________

Security Number *_________________________________________________________________________

*last 3 digits of number on signature strip on the back of the card

Amount to be charged $____________________________________________________________________

Signature_________________________________________________________________________________

All donations are processed through PAYPAL’s secure site.

If there is a specific reason for donating, please indicate below:

_____In memory of _____________________________________________________________ .

To celebrate my ____ wedding anniversary; _____ birthday; _____ graduation from_____________ .

_____ School supplies for students. _____ Books for students. _____ Miscellaneous

_____ Playground equipment. _____ Educational software. _____ Electronic equipment

_____ Please count me in as a monthly gift partner in the amount of $50.00 or ($_____) to be charged on the _____ day of the month.

_____ Other ___________________________________________________________________