Donation/Pledge Form Bridge to a Shared Perspective

Donation/Pledge Form

Capital Campaign for Perquimans Arts League
I wish to make a: *

Donation Pledge
In the amount of $ total dollar amount of donation or pledge*
Pledges may be paid over three years.
Date established *

Month Day Year
today's date
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Installment period, if making a pledge: *

Annually Semi-annually Quarterly Monthly NA
Installment amount, if applicable
Pledge Payment start date, if applicable

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
Signature

Clear

AMOUNT TO BE DONATED

USD Description