Food Lifeline - Working to Feed Hungry People in Western Washington

Monthly Donation Form

You can make monthly donations to Food Lifeline through your checking account, credit card, or by mail. Just let us know how much you would like to contribute each month, and your donation will automatically be transferred from your account to Food Lifeline.

Simply fill out and print the form below and submit online. Alternatively, you can print out the form, attach a voided check if necessary, sign and date the it, and send it to the address below.

Name

Organization

Address

City

State

Zip Code

Phone

Email

Monthly Donation
$ ($10 minimum)

I prefer to make Automatic Monthly donations through my:
Credit Card
Checking Account
Reminder Envelopes

For Credit Card Orders:

Type of Card

Credit Card Number

Security Code (3-4 digits)

Expiration Date

For Checking Account Orders:
For Online Submissions

Routing #

Account #

For those mailing in the form, please attach a blank voided check.

Receipt
We will acknowledge your gifts annually in January.

Authorization
I authorize Food Lifeline to make the above automatic monthly transfer from the selected account. This authorization will remain in effect until I notify Food Lifeline in writing that I wish to change my contributions.

For those mailing in the form, please complete the information below.

Signature

Date

Send Completed Form To
Please print out and send this completed form to:

Food Lifeline
Monthly Donor Program
1702 NE 150th Street
Shoreline, WA 98155-7226