H.O.P.E.
Michigan Humane Society
30300 Telegraph Road, Suite 220
Bingham Farms, Michigan 48025

Choose Your Method of Payment:

Bank Transfer: I authorize my bank to pay the Michigan Humane Society each month the amount entered above according to the terms of agreement below. I have enclosed a check for my first month's gift from the account I wish to use.

Credit Card: I authorize the Michigan Humane Society to charge my credit card each month for the amount entered above.

Credit Card Number:________________________________

Name on Card:________________________________

Card Type Visa Master Card American Express Discover
Expiration Date:______/_______
Security Code (3 digit code on back of card):_____________

Complete the Following:

Mr., Mrs., Ms., Miss, Dr.

First Name/MI/Last Name: _________________________________

Street Address: __________________________________________

City/State/Zip: ___________________________________________

Email Address: __________________________________________

Phone: (______)__________________________________________

Signature:_______________________________________________