Action Form

Welcome to the Action Form and thank you for your commitment to help. Below is the form we will need. If you have questions please contact Lightworker at (702) 871 3317 in the Pacific Time Zone.

There are 4 simple ways to process your donation:

1. For donations in any increment please use the Lightworker store. For odd amounts or recurring donations please choose the correct selection. This is a secure form.. The Lightworker Store is a Secure Environment to ensure safety.

2. Telephone You can call Lightworker at any time and talk to a real live person. Although it is the least secure of all the options, we would love to talk to you.
702 871 3317 9am to 4pm Pacific Time

3. Fax
You can Print out this form below after completion and fax it to Lightworker:

(702) 396 3316 Please note: Telephone and fax lines are NEVER secure.

4. Mail (Snail Mail) Please use the form below for secure credit card and checks. Fill in and print it upon completion. The form below is secure as the information never leaves your computer until you send it to us via mail. It is only printed on your computer. Once complete hit Print Form below and send the printed form to:

Lightworker
5351 N. Lisa Ln.
Rear Bldg Side Ent.
Las Vegas NV 89149-4612

Thanks for your support. Together we are making a difference!

Enter You First Name
Last Name
Mailing Address
Address cont (Apt,Suite# etc)
City
State or Province Abrev
Zip or Postal Code
Country (other than USA)
Phone number (Needed for Credit Card)
E-mail Address (Lower case only please)

Please choose Program:
(See program descriptions below.)

Program Descriptions:

Monthly Seeds of Light
Once we receive this form in the mail we will charge your credit card or Visa or MC debit card, once a month for the dollar amount and time that you specify. We have provided this option for ease of use. This can be changed at any time and is not a contractual agreement. If you have any difficulty understanding the form please put "CALL ME" in the comments box with your contact information and we will call you before we process the first charge.

Singe Donation
This is the same as above but is a one time offering.

Other
Tell us your preference below:

Comments:

Is this to be an Anonymous Gift? Click here. You will not recieve a recipt.

You will receive a donation receipt in the mail after your donation has been processed.

*Pay Method For Check please skip to the bottom and print form.

Amount in US Funds (If monthly program was chosen, this would be the monthly amount)
CVV2 What is this?
Enter Credit Card Number
Expiration Date (Example: 05/02)
Name on Card if different from above.
Address Credit Card bill is sent to if different from above.
Zip Code card bill is sent to if different from above.

		This information never leaves your computer
We are changing our reality - - - One heart at a time. Together we are bringing Home to this side of the Veil!