donation form

Sign me up for City Life/Vida Urbana's monthly giving program!

I want to play an active, ongoing part in maintaining City Life’s organizing over the long haul and strengthening City Life’s ability to respond to emerging needs in the community.

___ Please charge $______ monthly to my credit card

Name on card _____________________________________
Card # ___________________________________________
Exp. date ________/_________

___ I will make arrangements with my bank for automatic monthly payments of $______.

___ Please contact me about other mechanisms for making a monthly gift.

I understand that I may cancel this arrangement at any time.

Signature ___________________________________________


Name___________________________________________
Street___________________________________________
City & ZIP___________________________________________
Phone___________________________________________
E-mail___________________________________________

Please return this form to Kay Mathew at City Life/Vida Urbana, PO Box 117, Jamaica Plain 02130

If you have additional questions, please contact Kay Mathew at (617) 524-3541 x311 (kmathew@clvu.org)