2022-Pledge-Program-Form

Pledge Form

Line of Duty Fund Pledge Program - 2022
Full Name *
Company Name
Phone Number

Area Code Phone Number
Email
example@example.com
Address *
City *
State *
Zip Code *
Amount of pledge you are agreeing to pay upon distribution of funds each time, on an injury or death from the NTF Line of Duty Fund (LODF
I, (Enter your Full Name) *
Pledge Amount (Enter dollar amount) *
Check One *

Please invoice me each time funds are distributed out of the LODF. Please deduct my credit card each time funds are distributed out of the LODF.
Credit Card Number *
Expiration Date *

Month Day Year
CVC *
(Extra code printed on your debit or credit card)
I authorize the National Towing Foundation to charge my credit card each time there is a LODF payout. *

Clear
Contact Info: Email - Angela@APTRA.net Phone - 602-863-3373
Should be Empty:

Pledge Form