To enroll in the HopeBuilder monthly giving program, please complete this form and mail it along with your donation to: HopeBuilders, Habitat for Humanity Pulaski County, 3805 W. 12th St., Little Rock, AR 72203. Be sure to enclose your check, credit card or bank information.
You may also fax your enrollment in to 501-376-1101.
[ ] Yes! I want to participate in the HopeBuilders monthly giving program!
Name: _______________________________________
Address: _____________________________________
_____________________________________________
City: _________________________________________
State: _________ Zip: ___________________________
Daytime phone: ________________________________
E-mail address: ________________________________
I will make my monthly gifts by: My first monthly gift is attached.
[ ] CREDIT CARD
By selecting this box, I authorize Habitat for Humanity International to charge my HopeBuilder pledge to my credit card automatically each month as indicated in the terms outlined below.
Monthly pledge amount (minimum $5 per month): $____________
Visa____ Mastercard____ American Express____ Discover____
Credit card number ______-______-______-______
Expiration date (MM/YYYY) ______-___________
Name (as it appears on card) _____________________
Signature - Required _________________________ Date: _________
[ ] I would like to receive my HopeBuilders statement by e-mail.
[ ] CHECKING ACCOUNT DEBITBy selecting this box, I authorize Habitat for Humanity International to deduct my HopeBuilder pledge from my checking account automatically each month as indicated in the terms outlined below.
Please enclose a voided check.
Monthly pledge amount (minimum $5 per month): $____________
Checking account number ________________________
Signature - Required _________________________ Date: _________
[ ] I would like to receive my HopeBuilders statement by e-mail.
Credit Card and Check Account Debit Terms of Agreement:
This authorization to charge my bank account or credit card account is just like writing a check to Habitat for Humanity International or making a charge on my credit card, except that it will be done directly.
I understand that each transaction will appear on my regular bank or credit card statement.
I further understand that this agreement will remain in effect until I notify Habitat for Humanity's HopeBuilder coordinator that I wish to change or suspend it, and Habitat has a reasonable amount of time to fulfill my request.
Questions? Call us 501-379-1580.
Form 43304w001