KLM International - Partnership by Credit Card


Thank you for partnering with us! Please fill out the form below for your monthly giving by credit card.


	Monthly Donation:
	Deduct from my account on this date each month:	5th 15th 25th

	Personal Information
	First Name:
	Last Name:
	Billing Address:
	City:
	State & Zip Code:
	Home Phone:
	Cell Phone:
	Email Address:

	Credit/Debit Card Information

	Card Type	Visa MasterCard American Express Discover
	Credit Card Number:
	Expiration Date (MM/YY):

YES! I authorize KLM International to deduct my donation from either my checking account or my credit/debit card account each month. I understand that I control my giving. If at any time I wish to discontinue automatic giving, I will notify KLM International in such a time and manner as to give the organization reasonable opportunity to act. Discontinuing service will not remove me from the KLM International mailing list, and I will still be able to make donations by other means if I so choose.