MCCL Monthly Donation Commitment Form

1. Personal Information

First Name

Last Name

Email

Phone

Address

Town/City

State

ZIP Code

2. Monthly Contribution Commitment for next 12 months

Select your monthly donation amount:

$100/- $200/- $300/- $400/- $500/-

Other Amount: $

3. Preferred Monthly Payment Method

Cash Check Bank Transfer

Agreement Section

Please read and tick (✓) each statement to confirm your understanding and agreement:

I am 18 years of age or older.
I agree to all Terms & Conditions (as set forth in this form and as may be amended from time to time by the Board of Trustees).

Terms and Conditions

By submitting this form, I, the donor, acknowledge and agree to the following terms:

Voluntary Contribution: I understand that this is a voluntary, charitable contribution to the Muslim Community Center Livingston (MCCL). It is not a fee for goods or services.
Payment Authorization: I hereby authorize MCCL to process the specified monthly contribution through the selected payment method.
Cancellation & Changes: I may cancel or change my contribution by providing written notice to the MCCL Treasurer at least 10 business days before the next scheduled payment date.
Use of Funds: I understand that contributions will be used to support MCCL's mission, operations, programs, and capital needs as determined by its Board of Trustees.
Public Acknowledgment: I grant MCCL permission to acknowledge my support in its publications and media, unless I choose to remain anonymous.

☐ Check here if you wish to remain ANONYMOUS and not be publicly acknowledged.

Electronic Signature

Draw your signature in the box below:

Print Name

Date (mm/dd/yyyy)