Automatic Credit Card Billing Authorization Form

Yes, I would like to support Seeds of Light’s General Fund with a monthly contribution and would like to enjoy the convenience of automatic billing.

Your credit card will be billed monthly for the amount indicated below and CoreLight will appear on your credit card or bank statement for this monthly transaction. All requested information is required.

Customer Information

Customer Name:
*
Phone:
*
Email (to receive SOL e-newsletter and updates):
*

Payment Information

I authorize Seeds of Light to automatically bill the card listed below on a monthly basis as specified:

Amount: $
*
Start Billing On:
*/ */ *
End billing when:
 Contract Expires When you notify us

Credit Card Information

Seeds of Light accepts the following credit cards: Visa, MasterCard, American Express, Discover

Card Type:
*
Credit Card number:
*
Expiration Date:
*/ *
Cardholder’s name:
*

Cardholder’s credit card billing address (required):

Address:
*
City:
*
State:
*
Country:
*
Zipcode:
*

* I agree to these terms and authorize CoreLight/Seeds of Light to process my credit card payment

By clicking submit, you agree to Seeds of Light's Privacy Policy and Terms and Conditions, and authorize your credit card to be processed through our secure payment gateway.

CoreLight (Seeds of Light's parent organization) is a tax exempt organization under section 501(c)(3) of the Internal Revenue Code. Federal Tax ID #74-2835378. No goods or services were provided for this contribution. Your donation is tax deductible to the extent allowed by law.

THANK YOU FOR YOUR SUPPORT!

CoreLight, 223 N. Guadalupe St. #275, Santa Fe, NM 87501 *phone: (505) 424-8844 * fax: (505) 424-8848


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