CHARITY PROGRAMS AND OUR SPONSORS

CREDIT CARD DONATION / AUTHORIZATION FORM

*indicate a required field

---

*I Would Like to Donate:	$
*To:	Internation Children's Fund Adoption for Everyone                                 Other Program
Credit Card Information
*Name on Card:
*Card Number:
*Expiration Date:
*Card Type:	EuroCard/MasterCard American Express Visa Diners Club/Carte Blanche
Prefix:
*First Name/*M.I./*Last Name
Suffix:
*Street 1/Street 2
*City/*State/*Zip
*Country:
*Phone/E-mail
Comments

PLEASE ACKNOWLEDGE THE BELOW STATEMENT BEFORE SUBMITTING THE TRANSACTION.

ALL CREDIT CARD TRANSACTIONS ARE NOT DISPERSIBLE TO ANY THIRD PARTIES AND ARE APPROPRIATELY PROTECTED. HOWEVER, IF YOU HESITATE TO SUBMIT CREDIT CARD INFORMATION ELECTRONICALLY, YOU CAN PRINT THE CREDIT CARD AUTHORIZATION COUPON BY DOWNLOADING IT IN PDF FORMAT AND SEND TO OUR PROCESSING CENTER: P.O. BOX 1478, BOSTON, MASSACHUSETTS 02446-0012 USA.

WITHIN 3 BUSINESS DAYS OF COMPLETION OF THE TRANSACTION, YOU WILL BE PROVIDED WITH AN APPROPRIATE STATEMENT ABOUT YOUR CONTRIBUTION OR OTHER CHARGE BY E-MAIL OR REGULAR MAIL, DEPENDING ON HOW YOU WILL SUBMIT THE TRANSACTION. TRANSACTION FEE UP OF UP TO THREE AND A HALF PER CENT MAY BE ADDED TO THE TOTAL AMOUNT OF PLACED CHARGE AUTOMATICALLY, IF YOU SUBMITTING A PAYMENT OTHER THAN DONATION.

I AGREE TO PAY THE TOTAL AMOUNT SHOWN ABOVE AND AUTHORIZE TO CHARGE MY CREDIT CARD IN COMPLIANCE WITH CARDHOLDER AGREEMENT FOR THE PURPOSES INDICATED ABOVE.

...BACK