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Donations

Thank you for making a difference in our community.

Print this form, fill in the necessary information:

  I would like to financially support this project with:
  □  a one time gift of  $________.
  □  a monthly gift of  $________. 
       
  If monthly:
    □ I would like to pay by check. Make checks payable to Discovery Counseling Center.
    (Automatic withdrawals can be set up by sending a voided check.  You can cancel at any time.) 
    □ I would like to pay by credit card.
     

Name: _______________________________________
Credit Card:    □ Visa    □ Master Card
Credit Card #: ______________________________________
Expiration Date:  ___/_____ Security Code ____

_______________________________       ____________________
Signature                                                        Date

To make this an automatic monthly credit card donation, you can authorize Discovery to charge your donation to this credit card by signing below.  You may stop your donation at any time by contacting Discovery Counseling Center.                                                                                          
_______________________________       ____________________
Signature                                                        Date
       
 
Contact information:
 
Name: _______________________________________

Address: _____________________________________

City, St, ZIP __________________________________

Email Address: ________________________________
       
 

Mail this page to:
     

Discovery Counseling Center
17705 Hale Ave. Suite I-5
Morgan Hill, CA 95037