Yes, I would like to help the Salvatorians with my financial contribution!

Please Complete Entire Form

 

Title:______      Full Name:____________________

 Address:__________________________________

City:_________   State:____________   Zip:______

Phone Number:______________

Email Address:_______________

Monthly Donation Amount: $___________

Credit Card Number:______________________

(we accept Master Card, Visa, Discover, and American Express)

Credit Card Expiration Date:_______________

By signing this form you authorize the Society of the Divine Savior to charge the said amount to your credit card the first week of each month.

Signature:_________________   Date:__________

Mail to: Society of the Divine Savior

               1303 Milwaukee Dr

               New Holstein, WI  53061

Any questions or to sign up for this program please call us today at  1-920-898-4201 ext 302 or email at sds@salvatoriancenter.com attn: Deb.