Please provide the following information then click the CONTINUE button:

Mr./Ms.	* First Name:       * Last Name:
Title:
Company  Name:
Street Address:	Floor/Suite:
* City:	* State:   Zip Code:
Telephone Number:	Fax Number:
E-mail Address:	Date:  Monday, May 15, 2006 10:42 PM

 

 

                               

 

 

 

 

 

 

        * Enter or select the amount you wish to donate then click the CONTINUE button:

 

             Enter an amount

Enter an Amount:  $                

 

or  select an amount to donate

 

$100.00  $200.00  $500.00  $1,000.00  $2,500.00  $5,000.00

 

 

 

 

 

 

 

 

        * Please choose your method of payment:

 

 

* (Click on your choice)

 

CREDIT CARD	CHECK	PLEDGE
Please complete the form below	Mail your check to the address below	A pledge reminder will be sent to you

             Enter name on card

             Enter card number

 

 

             Enter expiration date

 

 

             Select type of card

Thank You !

 

You have chosen to make your donation by credit card:   

                                                                      

                    Please complete this form then click the CONTINUE button:

* Amount to be Charged:	$              Enter total amount
* Credit Card:	Select Type of Credit Card VISA MasterCard American Express Diner's Club Discover
* Cardholder's Name:
* Credit Card Number:
* Expiration Date:	-- (mm/yy)

By submitting this form, you are representing that the credit card entered is valid; that you are authorized  to use this credit card and, you are voluntarily giving CORE  permission to charge this credit card for the amount indicated.

      

 

 

 

 

 

Thank You !

        You have chosen to make your donation by check or Money Order:  

                                                                                                             

            Please write down this information then click the CONTINUE button:

 

             Enter Total Amount

Make check or Money Order payable to:	CORE - Congress of Racial Equality
Check Amount:	$
And mail it to:	Congress of Racial Equality
	817 Broadway  3rd Floor
	New York, New York  10003
	Attn:  On-Line Donation

      

 

 

 

Thank You !

 

             Enter Total Amount

 

        You chose to pledge a donation to CORE:  Amount: $

                                          

               Please select one of the following options then click the CONTINUE button:

 

                         Mail the pledge reminder to me at the address already provided above

                         Mail the pledge reminder to the following address:

 

Mr/Mrs:	First Name:     Last Name:
Company Name:
Mailing Address:	Suite/Floor:
City:	State:       Zip Code:

                   

                         Have someone contact me regarding my pledge at:

 

Telephone #:    Best time to call is between: and  (indicate AM or PM)

 

 

      

 

 

 

 

 

 

 

Review Choices

 

 

        Please review and/or complete the choices you have made:

 

 

             Enter Total Amount

Donation Amount:	$
Method of Payment:
Pledge Option:

 

 

 

 

 

 

 

Thank You !

Use this area to enter any comments you may have then click the SUBMIT FORM button:

CORE enjoys a 501(C)3 status with the Internal Revenue Service.

Contributions to CORE are tax deductible to the extent allowed by law.

 

For your protection, information on this form is transmitted directly to 

CORE's Fundraising Department  via a secured line.

Information entered on this form is confidential and will not be shared or sold.