Alrasool Islamic Center

                                               

Donor Information (please print or type)

Name

 

Address

 

E-Mail address

 

 

Phone (home):__________________ 

 

Phone (mobile):____________________

 

Pledge Information

I pledge a total of $____________________ to be paid: now monthly quarterly yearly.

I plan to make this contribution in the form of: cash check credit card other.

I wish to have our pledge/gift remain anonymous.

Signature:

Date

Please make checks or other gifts payable to:    Alrasool Islamic Center

5311 Stage Road

Memphis, TN 38134