Donation/Pledge Form Bridge to a Shared Perspective

Donation/Pledge Form

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

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

MonthDayYear
today's date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

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

AnnuallySemi-annuallyQuarterlyMonthlyNA
Installment amount, if applicable
Pledge Payment start date, if applicable

MonthDayYear
Method of payment*

Cash delivered to PAL Gallery, 109 N Church Street Hertford NC 27944Check to be mailed to Perquimans Arts League, P.O. Box 134 Hertford NC 27944Credit CardStock
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 TODAY

USDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year