Name:______________________________________________________________________

1. “Those who (in charity) spend of their goods by night and by day, in secret and in public, have their reward with their Lord: on them shall be no fear, nor shall they grieve.” [Al-Baqara: 274] MYCC-RDU Donation Form Name:______________________________________________________________________ First Name Middle Last Name Phone Number: (919) ____ _____ E-mail Address:___________________________ Home Address: _______________________________ City: ___________ Zip code_________ Donation Information (Check 1 box on each line) For the sake of Allah, I would like to make a donation(s) of: ☐ $50,000 ☐$25,000 ☐$10,000 ☐$5,000 ☐$1,000 ☐Other Amount $________ Contribution Type: ☐One time ☐Monthly (Number of Months:______) Payment Options ☐Cash ☐Check ☐Please charge my donation to my credit card (Please check credit card provider) ☐MasterCard ☐Visa ☐American Express ☐Discover Credit Card Information Card Number:__________________ Expiry:___________ Security Code:_____ Name on Card:______________________ Signature:________________ Please make checks payable to: MYCC-RDU MYCC Tax-ID: 27-3356730 “Those who (in charity) spend of their goods by night and by day, in secret and in public, have their reward with their Lord: on them shall be no fear, nor shall they grieve.” [Al-Baqara: 274] MYCC-RDU Donation Form Name:______________________________________________________________________ First Name Middle Last Name Phone Number: (919) ____ _____ E-mail Address:___________________________ Home Address: _______________________________ City: ___________ Zip code_________ Donation Information (Check 1 box on each line) For the sake of Allah, I would like to make a donation(s) of: ☐ $50,000 ☐$25,000 ☐$10,000 ☐$5,000 ☐$1,000 ☐Other Amount $________ Contribution Type: ☐One time ☐Monthly (Number of Months:______) Payment Options ☐Cash ☐Check ☐Please charge my donation to my credit card (Please check credit card provider) ☐MasterCard ☐Visa ☐American Express ☐Discover Credit Card Information Card Number:__________________ Expiry:___________ Security Code:_____ Name on Card:______________________ Signature:________________ Please make checks payable to: MYCC-RDU MYCC Tax-ID: 27-3356730