Friends of Free Speech TV Mail-In Donation Form

Friends of Free Speech TV Mail-In Donation Form

Yes! I support Free Speech TV -- the nation's first television network dedicated to broadcasting perspectives excluded by mainstream media.

Donation Form FAQ:

· Where do I send my form and contribution? Friends of Free Speech TV ~ PO Box 44099 ~ Denver, CO 80201

· To whom do I make my check or money order payable? Free Speech TV

· Where to I direct questions about my contribution? friends@freespeech.org

· What is Free Speech TV’s Privacy Policy?
All personal information is protected and remains private and confidential. Free Speech TV does not share or sell its donor lists.

Donor Information:

First Name	Middle Name or Initial		Last Name
Organization Name if this is a contribution from an organization or company
Street Address
City	State		Zip
Email Address		Phone Number

O First Time Donation

O Renewal

O Additional Gift

O Recurring Donation

One-Time Donation Amount:

O $50 O $75 O $125 O $150 O $200 O $300 O $400 O Other $ ________

Recurring Donation Schedule:

Amount $		O Per Month O Per Quarter	Until (mm/dd/yyyy)
O Automatic credit card transaction	O Bill me			O Don’t bill me, I will send payment

Credit Card Information:

O Visa

O Mastercard

O American Express

O Discover

Account Number
Expiration Date (mm/yy)	Card Holder Name

Donor Recognition:

O Please publish my name in Free Speech TV donor recognition lists as:
O Please do not publish my name in Free Speech TV donor recognition lists.