Charlie's Lunch

Donation Form

Name: ___________________________________________________________________

Address:__________________________________________________________________

City:_______________________________ State:_____________ Zip:_________________

Phone #:__________________________________________________________________

Cardholder Name:______________________________________________

Card Type: Visa / Mastercard (circle one)

Credit Card #:______________________________________________

Expiration Date:_____________________________

Check # (if check):___________________________

Amount of Donation:__________________________

Donation Type: (check one)

*Monthly ( )
One Time ( )

*If monthly donation we will process your donation each month and send you a receipt.

Mail this form to:

Charlie’s Lunch
P.O. Box 12428
El Paso, TX 79913