MAIL-IN

DONATION FORM
To make a donation by mail, please type or clearly print your information into
this form and mail with a check or money order payable to CityHeart Church:
CityHeart Church, 1060 E. County Line Rd. #3A-163, Ridgeland, MS 39157
Your generosity will create opportunities for our community to experience a lifechanging relationship with Jesus Christ.

DONOR INFORMATION
First Name: ________________________

Last Name: ____________________________

Company/Organization (if applicable): ______________________________________

Address Line 1: _______________________________________________________________
Address Line 2: _______________________________________________________________
City: __________________

State: ________

Zip/Postal Code:___________________

Primary Phone #: ___________________________

GIFT INFORMATION
MONTHLY DONATION AMOUNT (check one):
$25 $50 $100 $250 $500 $1,000 Other Amount ($) _____________
To make a one-time donation, please enter the amount here: $________________
Want to give online using your credit/debit card?
Simply visit cityheartjackson.com and click the Give button.

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Email Address: _______________________________________________________________

CityHeart Church is a 501(c)(3) nonprofit organization. Your contribution is tax-deductible to the extent allowed by
law. No goods or services were provided in exchange for your generous financial donation.