CONFIRMATION OF YOUR CONTRIBUTION on
May 10, 2007
Thank you for your contribution of $150.00
The Total Amount above will be Charged to:
Name on Credit Card: Michael Brown
Type of Card:
Card CCV # on Back:
Card Billing Address:
507 Main Str. Fairfield, Conn. 06614
If the information above is not correct please use the back button, make the
correction and then resubmit
the corrected information. Your card "Will Not Be Billed Twice".
All credit card transactions will be processed by Y.E.S.S. CARD INC.
Print this page for your records, then proceed by clicking on the
Thank you for taking the time to complete our secure online contribution form.
Darryl & Pamela
Print this page for your proof of purchase.