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 $ effective (date) The frequency of the charge of this amount will be: One Time Monthly Quarterly Annually
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: MasterCard Visa Discover
Credit Card Number (16 digits):
Expiration Date: (mm/yy)
Exact Name as it Appears on the Credit Card:
Name (serves as signature of agreement):
Address:
City/State/Zip:
