Visa/MasterCard Authorization form

Donor Information I prefer to donate by        
Name Visa Debit/Credit Card       
   card #                                   Exp. date  
Address
 		 MasterCard Debit/Credit Card
   card #                                   Exp. date
City, State, Zip
 		 Signature_____________________________

 

I hereby authorize Big Zeke's POWER KIDS, it's officers or assigns to complete this donation as a credit to the card listed above.  By my signature, I hereby represent and certify that I am over 18 years of age and the legal cardholder.

I understand that Big Zeke's POWER KIDS is a 501(c)3 non-profit organization, and a receipt will be mailed to me at the above address for tax purposes.