Name * Phone Number * Email I would like to give * Enter the dollar amount of your gift. Giving Frequency * Monthly until terminated by me Monthly for the number of months indicated below One time Number of Monthly Payments Complete this field if you selected the option for monthly payments for a specified number of months My monthly gift will be given on Enter the day of the month (e.g., 1 for the 1st) that you will give your monthly gift. I will pay by * Bill Pay (set up by me with my bank) Check (with memo "LIA") Cash (with envelope marked "LIA") Credit card (info below) Name on Credit Card Billing Address City State Zip Code CVC/Security Code Card Number Expiration Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021202220232024
