Untitled Page

Choose the FCA Ministry you want to support:

In support of FCA Org : 1081Y200

(change)

Ministry Address:	Bob Wiedemann
	FCA
	525 W Magnolia Circle
	Alpharetta, GA 30005

Your Contact Information

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

E-Mail:

Your Monthly Gift

Gift Amount:

Method of Transfer:

Checking Account

Credit Card

Method of Transfer:

Checking Account

(1)	Name On Check:
(2)	Bank Routing Number:
(3)	Bank Account Number:

Special Instructions: (Optional)

I authorize Fellowship of Christian Athletes to transfer from my checking account or charge to my credit card account, on the 20th day of each month, the amount I have shown above. I agree to notify FCA by mail, fax, or E-Mail to change or cancel this agreement.

Please check to agree

Method of Transfer:

Credit Card

Credit Card:

Name On Card:

Account Number:

Expire Date (MM/YY):

Security Code:

Special Instructions: (Optional)

	Please check to agree