Oxford Enrichment Fund
Monthly Donation by Credit or Debit Card

Authorization:
I hereby authorize the Berkeley Public Education Foundation to charge my credit/debit card each month as a tax-deductible contribution to support Oxford Elementary School - Oxford Enrichment Fund.

Payment Information:

Check one: ___ Credit Card ___ Debit Card

Check one: ___ Visa ___ MasterCard

Name on the card:__________________________________________________________

Billing Address: __________________________________________________________

Card Number: _____________________________________________

3-digit code on the back of the card: ___________

Expiration Date: ______________

Contribution amount per month: $_______________

Debits to be made monthly, beginning _____________________(day/month), 2007, for a period of ________ months, or until I notify the Foundation to stop the debits.

Signature of Card holder: ___________________________________________

Date: ________________

Please return this form to the Oxford Office (Principal or Secretary), or send to:
Berkeley Public Education Foundation - Oxford Enrichment Fund
1835 Allston Way
Berkeley, CA 94703

The Berkeley Public Education Foundation is a tax-exempt, 501(c)(3) organization, federal tax identification number 94-2918219.

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Last updated on 1/17/07