PTPC Legacy Fund Pledge Form
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
I/We pledge the following to the Legacy Fund:
Please Select
Cash
Securities (stocks, bonds, funds, etc.)
Real Estate
Other Asset
Total Pledge Amount:
Please stipulate whether 1) During lifetime(s) or 2) Bequest through estate or will
Special Instructions / Designation:
Donor Signature
Co-Donor Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
Should be Empty: