Monthly Giving Program

Please print the form below, fill it out and mail to:

U.S.ENGLISH Foundation

1747 Pennsylvania Ave., Suite 1050

Washington, DC 20006

Attn: Membership Department

Amount
By submitting this form, I authorize U.S.ENGLISH Foundation to automatically charge a pledge in the amount shown below to my credit card every month. I understand that this agreement will remain in effect until I notify U.S.ENGLISH Foundation that I wish to change or cancel my pledge.
Amount:	¨ $5      ¨ $10      ¨ $15      ¨ $20      ¨ Other $______
Contact Information
First Name:
Last Name:
Address:
Unit: (Optional)
City:
State:
Zip:
Phone Number:	(      )      -
Email:
Credit Card Information
Credit Card Number:
Credit Card Type:	¨ ¨ ¨
Expiration Date:
Name on Credit Card:
Signature:
Because the U.S.ENGLISH Foundation is a 501(c)(3) nonprofit tax-exempt organization, all contributions are fully tax-deductible.