Eparchial Appeal

Holy Protection of Mary Byzantine Catholic Church

2021 EPARCHIAL APPEAL

Donation/Pledge Form

Last Name ___________________________________ First Name ______________________________________

I belong to (or want my donation credited to) the parish of ______________________________________________

My Address: (Street) _____________________________________________________________________

(City, State, Zip Code) ______________________________________________________________

E-mail ____________________________________ Telephone ___________________________

____ I am making a pledge or donation to the 2021 Eparchial Appeal for the Eparchy of Phoenix in the amount of

___ $____________ ___ $1,000.00 ___ $2,500.00 ___ $ 6,000.00

___ $300.00 ___ $1,250.00 ___ $3,000.00 ___ $ 7,500.00

___ $500.00 ___ $1,500.00 ___ $3,500.00 ___ $10,000.00

___ $750.00 ___ $2,000.00 ___ $5,000.00 ___ $__________

Payment Methods:

1. For Full Payment Now by Check, Money Order, or Credit/Debit Card:

_____ I am making the payment on my pledge in full. My check no. ________________ or Money Order is enclosed

in the amount of $ _____________________ payable to the ‘Eparchy of Phoenix’

OR

_____ Charge my credit/debit card as indicated on the reverse side of this form in the full amount of $ ___________

(Please be sure to complete credit/debit card charge authorization information on the back of this form)

2. To Make Installment Payments:

_____ I will make a total of ___________ payments to complete my pledge of $ _______________

in one of the following two ways:

_____ By Check or Money Order (please do not send cash) _____ Send me Payment Envelopes

Enclosed is my first payment in the amount of $ ________________

OR _____ By monthly authorized charges to my credit card in the amount of $_________________ each

(Total pledge amount divided by number of desired payments)

(Please be sure to complete credit/debit card charge authorization information on the back of this form)

Please use the enclosed postage-paid envelope to return this completed form

and any accompanying payment (please do not send cash) – Thank you!

CREDIT/DEBIT CARD PAYMENT AUTHORIZATION FORM

Please provide the following information to authorize Holy Protection of Mary Byzantine Catholic Eparchy of Phoenix to charge your credit/debit card listed below for your gift to the 2021 Eparchial Appeal. For processing please return this entire Donation/Pledge form to the Eparchy in the postage-paid envelope provided.

I, ________________________________________________________________ hereby authorize

Holy Protection of Mary Byzantine Catholic Eparchy of Phoenix

to charge my credit/debit card indicated below for $ _____________ now (for full pledge payment) or

$____________ on the _________ day of each month for _________ months (for installment payments)

for payment of my pledge to the 2021 Eparchial Appeal

Name as shown on Credit/Debit Card ____________________________________________________________

Billing Address: __________________________________________________________________________

__________________________________________________________________________

Telephone No. (______) ____________________ e-mail _________________________________________

Card Type (Check One): ___ Visa ___ Mastercard ___ American Express ___ Discover

Cardholder Name __________________________________________________________________________

Account (Card) Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Expiration Date _________________ Security Code (3 digit no. on back of Visa/MC) _______________

(mm/yy) (4 digit no. on front of AmEx) _______________

_____________________________________________________ _________________________

My Signature Today’s Date

By my signature above I authorize Holy Protection of Mary Byzantine Catholic Eparchy of Phoenix to charge the credit or debit card indicated in this authorization form according to the terms outlined above. This payment authorization is only for the donation described above, only for the amount(s) indicated, and is valid for this one purpose and pledge fulfillment only. I further hereby certify that I am an authorized user of the credit or debit card referenced and that I will not dispute the payment with my credit or debit card issuer provided the authorized transactions correspond to the directives I have indicated on this form.