One-Time

Butterfly Club Donation

To make your One-Time Donation, just complete this form and return it to us by 
mail along with your donation. It’s as easy as that!

Send form and donation to: 

 

 Att: Butterfly Club

 6050 Santo Road, Suite 145

 San Diego, CA 92124

Please fill out the needed information below:

 Your name: _________________________________________________

 Address: ___________________________________________________

 City: ___________________ State: ________ Zip Code: __________

**Make out your tax-deductible check to Community Catalysts of California, use your 
credit card or have it deducted from your next paycheck!

DONATION: The amount of my gift is for: $___________ . _______

 

 Please deduct from my next paycheck

 Signature Required: ___________________________________________

 

 Check Enclosed

 Please charge my credit card

 

 Mastercard Visa American Express Discover

 

 Card Number: _______________________ Expiration Date: __________

 Signature: __________________________ Date: __________________ 
(required for CC payment option)

Your gift made payable to Community Catalysts of California is tax-deductible to the
full extent of the law.

Thank you for your contribution!