Brick Form

I / We would like to Donate a Brick for My/ Our Marhumeen

My/ Our Name My / Our Street Address (City) (State) (Zip) (Telephone Number) (Cell Number)

I/We hereby authorize I.E.C Husaini and their financial institution
to make withdrawals of the amount stated here under from my bank account. Please attach a copy of voided
check, If possible. Number of Bricks for Marhumeen ( if writing check make it payable to IEC Expansion Project)

$250x=for the following Marhumeen

My Bank Account Details

Bank Name
Bank Address
Bank Routing Number
Amount Withdrawal $ Signature

Payments can also be made via Credit Card

Your Pledge will be charged on or near 15th of each month. Please inform us of any changes to your credit card information by contacting fundraising leaders or

Card # Name on Card

Exp. Date Security Code

Billing Address City State Zip

Signature Date

Record all infromationon on this form. Make all checks payable to IEC Expansion Project. Don’t mail cash. Tax deducatable receipts will be mailed for
contributions over $250/yr. You can download additional forms from IEC website IEC is a registered charitable organization
with IRS with Federal Tax ID # 23-7223818. IEC has permission from Marja to accept Khums. Label the envelope “Donate a Brick for Marhumeen Project”