Checkomatic / pledge donation form

Name:____________________________________________________________________________________

Address: __________________________________________________________________________________

Phone:(daytime) __________________________________Evening: ___________________________________

E-mail: ____________________________________________________________________________________

Amount Pledged: $ 10 $25 $50 $100 and more per month or one time donation (circle one).

________________________________

Signature

Please fill up this form and mail with a void check to:

American Muslim Voice
P.O. Box 1489

Fremont, CA 94538

Phone: 650-387-1994