Donation/Pledge Form
Capital Campaign for Perquimans Arts League
I wish to make a:
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Donation
Pledge
In the amount of $
total dollar amount of donation or pledge
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Pledges may be paid over three years.
Date established
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Month
-
Day
Year
today's date
Name
*
First Name
Last Name
Address
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Street Address
Street Address Line 2
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Postal / Zip Code
Email
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example@example.com
Phone Number
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Installment period, if making a pledge:
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Annually
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Quarterly
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Installment amount, if applicable
Pledge Payment start date, if applicable
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Month
-
Day
Year
Method of payment
*
Cash delivered to PAL Gallery, 109 N Church Street Hertford NC 27944
Check to be mailed to Perquimans Arts League, P.O. Box 134 Hertford NC 27944
Credit Card
Stock
If stock is being donated, please list name of stock
Number of shares being donated, if applicable
Approximate value of stock, if applicable
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