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Text Box: 1.
 
  
 
 
  First Name/Company Name   MI   Last Name    
                                                       
  Social Security Number   Company Tax ID  
         -      -                -                 
  Address           City      
                                                       
  State   Zip Code       Telephone Number          
                           -        -          
Text Box: 2. Text Box: CONTRIBUTION OPTIONS
Text Box: Monthly Contribution x ____ year(s)
Text Box: Complete see Section 3 ___
Text Box: 3.
Text Box: CONTRIBUTION AMOUNT
Text Box: Please indicate the contribution value:
 
                  
                 
                 
 
 
 
  $         .      
Text Box: Bank or Credit Union Account Number
 
    
 
   
                                                   
Text Box: Automatic contribution from Credit Card
Text Box: Discover
Text Box: Expiration Date
 
  
 
   
   
                                                   
Text Box: Month Text Box: Year
Text Box: 4. Text Box: AUTHORIZATION
Text Box: Please sign and date the authorization below
Text Box: I authorize Valley Soccer Foundation to initiate credit/debit entries to my bank account/credit card (and to initiate, if necessary, debit/credit entries and adjustments for credit/debit entries made in error) and I agree to provide the necessary information to allow Valley Soccer Foundation to initiate such entries, and authorize my depository institution/credit card company (the "Depository") to credit and/or debit such amounts to my bank account. I understand that my authorization shall remain in full force and effect until Valley Soccer Foundation receives written notice from me terminating my authorization, provided that my notice is provided to Valley Soccer Foundation in such time and manner as to afford Valley Soccer Foundation a reasonable opportunity to act on it. Any such notice must be sent to Valley Soccer Foundation at the following address: Valley Soccer Foundation, 1620 E. Bulldog Lane, Fresno, CA 93740. I agree to indemnify and hold harmless Valley Soccer Foundation and my Depository for any loss, liability or expense incurred from acting on these instructions.
 
  
 
 
 
 
 
 
 
 
 
   
 
 
 
                                                   
  Bank Account Owner's Name (print)   Joint Bank Account Owner's Name (print)  
     
 
                                                   
  Bank Account Owner's Signature                     Date   Joint Bank Account Owner's Signature                     Date  
 
 
  
 
 
 
 
 
 
 
 
 
 
Text Box: "FOUNDATION MEMBER" LEVEL EACH DONOR THAT CONTRIBUTES $240 ANNUALLY IS A VOTING MEMBER OF THE VALLEY SOCCER FOUNDATION. EACH $240 INCREMENT INCLUDES A SEASON TICKET TO MEN'S & WOMEN'S SOCCER HOME MATCHES.
Text Box: THE VSF AND THE IRS: 8O% OF YOUR CONTRIBUTION MAY BE TAX DEDUCTABLE. IT IS RECOMMENDED THAT YOU CONSULT YOUR TAX ADVISOR.
 
  
 
 
 
 
 
Text Box: Phone: 559-278-5435 FAX: 559-278-6363
 
  
 
 
Text Box: Return Address: 1620 E. Bulldog Lane, MS 87, Fresno, CA 93740
 
     

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