1. I would like to be a pledge partner of the Washington City Mission on a:

One Time Basis
Monthly Basis
Quarterly Basis
Yearly Basis

2. The dollar amount I would like to donate is $

3. Please choose the method by which you would like to donate:

            Please select Credit Card Processed on this Site Credit Card Info to be Phoned or Mailed in Check to be Mailed

4. Please provide the following contact and billing information.

PLEASE NOTE: If you are paying by credit card this billing address must match the address where your credit card statements are mailed.

Name:
Company:
Street Address:
Address (cont.):
City:
State:
ZipCode:
Country:

5. Please enter your credit card information:

Choose Credit Card:              Credit Card #:     Expiration Date (mm/yy):  Security/CVC Code: ==>

For MasterCard and Visa, Security/CVC Code:: last 3 digits on back of card

6. How did you hear about the Mission

     Please select Observer-Reporter Post-Gazette Union Finley Messenger Greene County Messenger Tribune-Review Other Newspaper WJPA WORD WPGB WANB Other Radio Web search Friend Church Other

7. I would like someone from the Mission staff to call me to obtain my payment information.

My phone number is and the best time to reach me is .
 

8. I would like to receive the Mission's E-Newsletter. My e-mail address is:

9. Please send me information on how I might include the Washington City Mission in my will.

10. I would like a tour. Please phone me at .

11.   I would like to arrange a tour on .
      Please phone me at      .

12. I would like to volunteer. Please send me an application.

13. I am willing to pray for the Washington City Mission.

14. I would like the Washington City Mission staff to pray for the following: