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Monthly Recurring Donation

On the ---1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th21st22nd23rd24th25th26th27th28th day of the month.

Name as it appears on your card*

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Exp. Date*
010203040506070809101112 20132014201520162017201820192020

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