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  • Pledge Form

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    Marian Ng
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    This donor/pledge form collects contact and payment information from donors committing to support Children's Mary Hospital. Donors provide their name, address, phone, email and intended donation amount and specify if it will support the general fund, education/outreach, a special event or other program. Donors also select a payment method, whether in full, on a future date after being invoiced, or in installments, and sign to confirm their pledge.

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    This donor/pledge form collects contact and payment information from donors committing to support Children's Mary Hospital. Donors provide their name, address, phone, email and intended donation amount and specify if it will support the general fund, education/outreach, a special event or other program. Donors also select a payment method, whether in full, on a future date after being invoiced, or in installments, and sign to confirm their pledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    10 views1 page

    Pledge Form

    Uploaded by

    Marian Ng
    This donor/pledge form collects contact and payment information from donors committing to support Children's Mary Hospital. Donors provide their name, address, phone, email and intended donation amount and specify if it will support the general fund, education/outreach, a special event or other program. Donors also select a payment method, whether in full, on a future date after being invoiced, or in installments, and sign to confirm their pledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    DONOR/ PLEDGE FORM

    Donor name(s)______________________________________________________________________

    Program Listing______________________________________________________________________

    Address____________________________________________________________________________

    City/State/Zip _______________________________________________________________________

    Phone ______________________________ Fax____________________________________________

    E-mail _____________________________________________________________________________

    By signing below, I/we are committing to the following donation/pledge to Children Mary Hospital

    Amount: _____________________________

    To Be Used for: ___ General Fund ___ Education/Outreach ____Special Event __________________
    (Check one) ___Production: ____ Other:

    Notes: ___________________________

    _____________________________________________________________________________________

    PAYMENT INSTRUCTIONS

    ___I am fulfilling the entire pledge at this time.

    ___I will pay the entire pledge on or before (please send me an invoice two weeks prior).

    ___I would like to be billed in installments of ___Weekly ___Monthly ___Beginning on ___ Check
    enclosed (payable to Musical Theatre West) ___Please charge my: ___ Visa ____MasterCard
    _____American Express ____ Discover Card Number Expires CVV Code

    ____ Other method of payment

    CONFIRMATION

    Signature_________________________ Date_______________

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