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If you wish to pay by check please print this form and mail it with you check to:

Ninos Latinos Unidos, Inc.
10016 Pioneer Blvd. Suite 123
Santa Fe Springs, CA 90670

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Your gift is fully tax deductible:

Please list me / us on your honor roll as:

First name
Last name
Street address
Address (cont.)
City, State, Zip
Country
Phone
E-mail

Choose one of the following programs:

			Amount/Cantidad
	The Circle Of Child Protectors El Circulo De Los Protectores De Niños	Any Amount Cualquier Cantidad
	Newborn Benefactors Club Club De Benefactores De Bebes	$100.00 - $249.99
	Infant Benefactors Club Club De Benefactores De Infantes	$250.00 - $499.99
	Adolescent Benefactors Club Club De Benefactores De Adolescentes	$500.00 - $999.99
	The Society Of Guardian Angels Sociedad De Los Angeles Guardiane	$1,000.00+

 

Please provide the following information:

BILLING
Credit card	VISA MasterCard American Express Diner's Club Discover
Cardholder name
Card number
Expiration date