$35 $60 $100 $250 $500 Other_____

Please charge $_______ to my VISA MasterCard
Card #_______________ Exp. Date (month/year) _________
Signature _________________________
Print card member name as it appears on the card: ______________________________

I prefer to make a Monthly Pledge.
1. Enclosed is my first gift of $_______
2. Balance due $_______
3. Amount due to be billed at

$10/month $25/month $50/month
Other $_______

Gift Recognition: ______________________________
(Please note how you would like this gift to be listed in newsletters and annual reports.)

Name: ____________________________________
Address: __________________________________
City, State, Zip: ____________________________
Daytime Phone: _____________________
Email: ______________________

Please print out this form and mail it to:

Chinatown Community Development Center
1525 Grant Avenue
San Francisco, CA 94133-3322