Westmont Monthly Support Enrollment Form (print and send)

Yes! I want to enroll in the Westmont Monthly Support Program.

Please accept my gift of $_____ per month to begin in (month/year) ____/____

Electronic Fund Transfer - My blank VOIDED check is attached.

Automatic Credit-Card Debit- credit card (circle one): Visa / Mastercard
Name on card:
Account #:
Exp. date:
First name:
Spouse name:
Last name:
E-mail:
Mailing address:
City, State, ZIP:
Home phone:
( )
Work phone:
( ) , ext.
Relationship to Westmont
(check all that apply):
alum parent friend current employee
other
ID (optional):
Please do not list my name in annual publications.  

I authorize Westmont to charge my account as indicated above. My Westmont Monthly Support Program enrollment will remain in effect until I notify Westmont that I wish to end this agreement, which I may do at any time. I will also notify Westmont of any changes in my account information.  

Signature: _______________________________________________  

Send enrollment form to:
Director of Donor Relations
Westmont College
955 La Paz Road
Santa Barbara, CA 93108