Information Clearing House Fax Donation Form

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Making a financial contribution to Information Clearing House using your credit or debit card.

Just fill out the information below. Then print this form and fax it to 952-516-2145 . If you are resident outside of the USA click here to find the international dialing code for the USA from your country.

If you prefer you may mail the information:-

If you prefer you may call my voice mail :- 952-516-2145

Information Clearing House
Po Box 365
Imperial Beach
CA 91933 - USA

Its that simple!

Leave a message and include your phone number.

A volunteer will call and get your donation information.

Its that simple!


Donation Details

Is this a one time only donation or a monthly pledge


Donation Amount:		$
Country:

First Name:

Last Name:

Card Type:

Card Number:

Expiration Date:

Card Verification
Number:

What's this? - The verification number is a 3-digit number printed on the back of your card. It appears after and to the right of your card number.

Using AmEx? - The American Express verification number is a 4-digit number printed on the front of your card. It appears after and to the right of your card number.

Email Address:


Home Telephone: (optional)