Yes! I want to be a part of Harvest's Extended Family and have included my gift for the daily expense of a child in need.

Mr.   Mrs.   Ms.   Rev.   Dr.   Other   

Name: Phone:

Mailing Address:

City, State, and Zip:

Home Church:

I have enclosed my gift of    36.05    72.10    108.15      

My gift is in    honor    memory of   

Charge my gift to my    American Express    Visa   Mastercard

Card Number         Expiration   

Name as it appears on card   

Signature   ________________________________________________