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    Sustainer Form

    Uploaded by

    sypermath
    This document is a sign-up form for an automatic monthly sustainer program for the Communist Party USA (CPUSA). It collects contact information and payment details to set up recurring monthly donations from a credit or debit card to support the party's work. The form authorizes the monthly charges and can be cancelled by written notice at least 15 days before each payment date.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Sustainer Form

    Uploaded by

    sypermath
    37 views1 page
    This document is a sign-up form for an automatic monthly sustainer program for the Communist Party USA (CPUSA). It collects contact information and payment details to set up recurring monthly donations from a credit or debit card to support the party's work. The form authorizes the monthly charges and can be cancelled by written notice at least 15 days before each payment date.

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    © Attribution Non-Commercial (BY-NC)

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    This document is a sign-up form for an automatic monthly sustainer program for the Communist Party USA (CPUSA). It collects contact information and payment details to set up recurring monthly donations from a credit or debit card to support the party's work. The form authorizes the monthly charges and can be cancelled by written notice at least 15 days before each payment date.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views1 page

    Sustainer Form

    Uploaded by

    sypermath
    This document is a sign-up form for an automatic monthly sustainer program for the Communist Party USA (CPUSA). It collects contact information and payment details to set up recurring monthly donations from a credit or debit card to support the party's work. The form authorizes the monthly charges and can be cancelled by written notice at least 15 days before each payment date.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    CPUSA Monthly Automatic Sustainer

    Program
    Date________________

    Name ______________________
    District _____________________
    Email _______________________
    Address_____________________
    City, State, Zip________________
    ___________________________
    Phone ______________________
     YCL member
    Sign me up! I want to be a
    regular supporter of the work
    of our Party and press.

    My monthly pledge is: $_________

    The method I prefer is:


     credit
     debit card

    I authorize the charge/deduction of my contribution to Fund for Progress II


    in the amount of $_____________ each month.
    Charge my debit/credit card: Visa ___ MC ___ Discover ___ AmEx ___
    Account number ___________________________ Expiration Date _______
    Name (as it appears on the card) __________________________________
    Billing address (if different from above)_____________________________
    Signature _____________________________________________________
    I acknowledge that the origination of deductions from my account must comply with provisions of U.S. law. I
    understand that my monthly bank/credit card statement should show the amount and date payment was made to Fund
    for Progress II. I understand that I am responsible for ensuring that the account designated has sufficient funds/credits
    on my automatic payment date to allow the automatic deduction/charge of my contribution.
    CANCELLATION: This authority shall remain in full force and effect, and the payment plan shall continue until
    written revocation received at least 15 business days prior to the monthly payment date. To cancel payment plan
    contact: Fund For Progress II, 235 W. 23rd St., NY, NY 10011.

    Completed forms can be mailed to Esther Moroze, 235 W. 23rd St., 8th Floor, NY,
    NY, 10011. For more information, please call (646) 437-5318.

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