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I hereby authorize Girl Scouts of Manitou Council to charge my credit card for the donation/pledge I am making to the council.
The amount of the donation will be $
The frequency of the charge of this amount will be:
Except for one time donations, this authorization will remain in force until Girl Scouts of Manitou Council receives written notification from me of its termination. I may revoke this authorization at any time.
Credit Card Type:
Credit Card Number (16 digits):
Exact Name as it Appears on the Credit Card:
Name (serves as signature of agreement):
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