Jackson Recovery - Services

For more information on the
Friends of Jackson Recovery Center program,
Click Here

Statement of Intent

I/We intend to contribute - personal, business and economic conditions permitting - the following:

Total Amount:	$
To be paid:
	in Full
	Monthly
	Quarterly
	Semiannually
	Annually
Date of first payment toward gift:
Bill To My:
	Visa
	MasterCard
Card Number:
Exp. Date:
If paid annually, the month to charge my card is for the amount of $ .

I/We are interested in making our gift appreciated securities or property. Please contact me/us.
My/Our gift may be eligible to receive a matching gift. Please contact me/us.
Gift Given in Honor of:
Gift Given in Memory of:

Signature:
Date:
Name:
Address:
City:
State:
Zip:
Phone:

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