2010 Melia Family Fundraiser
Credit Card Payment Authorization
Last Name_______________________ First Name_____________________
Middle Name or initial _____________ Phone # (____)__________________
Name on the Credit Card
___________________________________Donation Amount $________
Credit Card Billing address _____________________City________ State_____
□ Mastercard □ Visa □ American Express
Credit Card Number □□□□-□□□□-□□□□-□□□□
Expiration date: □□/□□ *□□□ Card Security Code
*In the signature box on the back of the card, you should see either the entire 16-digit credit card
number or just the last four digits followed by a 3-digit code. This 3-digit code is your Card Security
code. For American Express, enter the 4 digit code here. ___ ___ ___ ____
As the credit card holder, I hereby authorize Orphan’s Hope Project, Inc. to charge
the amount of $__________ to my credit card. This is a donation for Orphan’s Hope
Project, Inc. and will be used for the construction of the new girls’ house at Hogar
Miguel Magone Orphanage in Guatemala.
Cardholder Signature ________________________ Date _________, 2010
Card holder’s e-mail address _______________________
Your completion of this authorization form helps us to protect you, our valued donors, from credit card fraud.
Orphan’s Hope Project, Inc. will keep all information entered on this form strictly confidential.
Orphan’s Hope Project, Inc.
2631 Chapparal Court Pinole, CA. 94564
A non-profit 501(c)3 EIN 26-0261546