Centennial Campaign Pledge Form

FCD Centennial Campaign Pledge Form
Name

First Name Last Name
Preferred Mailing Address

Home Business
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email Address
example@example.com
Pledge Levels

Violet: $769.60 paid over 4 years
$192.40 per year; $16 per month

Pearl: $1,924.00 paid over 4 years
$481 per year; $40 per month

Fortitude: $2,024 paid over 4 years
$506 per year; $42 per month

Minerva: $5,000 paid over 4 years
$1,250 per year; $104.17 per month

Founders Circle: $7,696 paid over 4 years
$1,924 per year; $160 per month

Centennial Platinum: $10,000 paid over 4 years
$2,500 per year; $208 per month
Yes, I would like to support the Centennial Campaign with a tax-deductible gift/pledge at the following level:

Violet Pearl Fortitude Minerva Founders Circle Centennial Platinum
Schedule of Pledge

One Time Yearly Monthly
First Installment Date

Month Day Year
Date
Should be Empty:

FCD Centennial Campaign Pledge Form