I s l a n d   I m p a c t   I n t e r n a t i o n a l - [ donation pledge  form ]



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masterpeace.net ~  Donation  Pledge  Form  ~ masterpeace.net

We take Mastercard and Visa Donations  Online!

We take Mastercard and Visa

Donation  Pledge ...

Please fill in the sections below. Once you have completed this form, please click on the 'Submit' button. If you make a mistake, please make your corrections as necessary. If you need to clear the form, please click on the 'Reset' button.


Please note: ALL fields are required except for "donor number."

* All fields are required!
   

                                       Mailing Information . . .
 
* First Name:
  
* Last Name:
  
* Postal Address:
  
* Street Address
 
* City:
  
* State:
  
* Postal Code:
  
* Country:
  
 Phone - Country Code:
  
* Phone Number:
  
* E-mail Address:
  

 


* Comments:
  

                                       Pledge Information . . .

You can now choose to purchase one ticket, or you can make a pledge for a monthly contribution. Please select one of the radio buttons below:

A One Time Pledge,
or
A  Monthly  Pledge,
in the amount of:  $
Please enter your Donor Number: - (if you have one)

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If you are ready, please click on one of the buttons below:


     

 



We will mail to you a pre-addressed pledge return envelope,

which you should receive within 10 days.


 

        
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Send snail mail to:

Island Impact International
Red Shepard
Post Office Box 8877
Tyler, Texas 75711

  Telephone:  903.509.9005  



   
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