Here is my contribution to support your Universe Spirit mission.
$100 $250 $500 $1,000 $5,000 Other $________
by Check/Am Ex/MasterCard/Visa/Discover
OR
I will contribute $ ___________ each month
by Check/Am Ex/MasterCard/Visa/Discover
Signature __________________________________________
Card # ____________________________________________
Name on card ______________________________________
Expiration date ______________________________________
Telephone _________________________________________