Clone of CMFA Pledge Form and Agreement

CMFA Pledge Form and Agreement for Recurring Pledge
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Repeating Donation: A sum of:
Repeating Every:
Total Donation:
Total of Repeating Donations
Recurring Donation to begin:

MonthDayYear
Recurring Donation to end:

MonthDayYear
CMFA T-shirt choice:
Donor Preferences:
If Restricted, please tell CMFA how you would like your funds to be used:
Would you like for this donation to remain anononous?
Does your employer match donations?
Click here for the Pledge Agreement
Date of Donation

MonthDayYearHourMinutesAM/PM Option
PayPal
prevnext( X )
$10.00 Month/$120.00 year($10.00 for each month)

$15.00 month/$180.00 year($15.00 for each month)

$25.00 month/$300.00 year($25.00 for each month)

$50.00 month/$600.00 year($50.00 for each month)

$75.00 month/$900.00 year($75.00 for each month)

$100.00 month/$1200.00 year($100.00 for each month)

$200.00 month/$2400.00 year($200.00 for each month)
Should be Empty: