DONATION and PLEDGE FORM

DONATIONS

DONOR AUTHORIZATION AGREEMENT Your pledge to the Islamic Center is Tax Deductible. Tax ID #46-5043358 I (we) hereby authorize Islamic Center Downtown LA, herein after called Center, to initiate debits (for the purpose of donation) and the bank indicated below, herein after called Bank, to debit the amounts thereof to my (our) checking account indicated below.

Payment Method:

Amount:

	(One-time) Check—payable to ICODLA Cash
	Pledge—will fulfill by / /
	Monthly Automatic Withdrawal
	Bank—include voided check

$10,000	$5,000	$2,000
$1,000	$500	$100
Others $

*Personal Information* (a donation receipt will be sent to this address)
Name
Address
City	State /Province	Zip/Postal Code
Home Phone	Work Phone
ISLAMIC CENTER OF DOWNTOWN LA – 852, S.Santee Street, 1st Floor, Los Angeles CA 90015

DONOR AUTHORIZATION AGREEMENT Your pledge to the Islamic Center is Tax Deductible. Tax ID #46-5043358
I (we) hereby authorize Islamic Center of Downtown LA, herein after called Center, to initiate debits (for the purpose of donation) and the bank indicated below, herein after called Bank, to debit the amounts thereof to my (our) checking account indicated below.
Bank Name:	Branch:
Address:	City:
Account No:	State:	ZIP:
This authority to remain in full force until Center or Bank has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Center or Bank a reasonable opportunity to act on it; or until Center or Bank has sent me (or either of US) ten (10) days written notice of Center’s or Bank’s termination of this arrangement.
Name(s):
Date:	Signature:	Signature:
Please enclose a voided check or a deposit slip in this envelope. Thank You