Donation Form

Please PRINT OUT, fill in the information below and mail to us along with your tax deductible donation check.
Thank you for your support of Rosa Mystica. - Please tear off and return with your check payable to:

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Rosa Mystica Foundation of America
1121 Rte. 106N
Muttontown, NY 11732

Bill my Credit Card: Visa Mastercard Discover

Name on card (as shown)_________________________________

Billing address__________________________________________

City____________________State_____________Zip___________

Tel:____________________________email:___________________

Donation Amount $_________________

In Memory of _____________________________________

Dedicated to ______________________________________

Altar Flowers $35.00 Sanctuary Candle $35.00

Mass $20.00 Rose for Life $20.00(monthly)

Please send card to:
name______________________________________ address_____________________________________

City_______________________State_________Zip_____________

From________________________________________

Total Amount Billed________________
(501C) Tax ded.