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Islamic Center of Irving
P. O. Box 154401, Irving, Texas 75015-4401   Phone: (972) 721-9136  Fax: (972) 579-3309  

YES! I would like to help this project, please include my donation in building this Masjid

Please Circle Your Choices

$10,000            $5,000            $2,500            $1,000            $500            $100            Others $____________

Cash                Check #____________              Pledge                   Automatic Withdrawal

Name:     _______                                                                                                               Address:                                                                                                                                    
                                                                                                                                                
City:                                                     State:                                     Zip:                                 
Phone(w)  ____________________   Phone # (H) :  ________________
Email Address:                                                                                                                             

For Automatic Withdrawal please provide the following:

1) Voided Check      2)   Date Beginning ____/____/____       Signature ________________________ 

Your donations are tax deductible. Our Tax ID # 75-2408307

I give permission to the Islamic Center of Irving to withdraw the monthly pledge from my bank account(s)/credit card(s) each month. I will submit a written approval of any changes or terminations to the Islamic Center of Irving within a reasonable time to adjust their records accordingly.