Pledge Form

Pledge Form
I (we), Name(s) , notify Colorado Health Network of my (our) pledge of Pledge Amount . The payment terms and usage of the funds are outlined below.
Donor Information
Name (for formal acknowledgement)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Gift Information
Payment will be made according to following schedule:
Year of Payment Amount:
20   2-digit year     Amount for year 1
20   2-digit year     Amount for year 2
20   2-digit year     Amount for year 3
20   2-digit year      Amount for year 4
I (we) would like to make payments:
Beginning:

MonthDayYear
Date
Recognition Information

Donors will be recognized in campaign materials unless anonymity is requested.
Please use the following name(s) in all acknowledgements:
I (we) wish to remain anonymous
Please contact me to discuss naming opportunities
Payment Information
For payment, I would like to:

provide my credit card information to SCHN Staffsend a check to SCHNprovide my payment information over the phone
Please make checks, corporate matches, or other gifts payable to: Colorado Health Network

Colorado Health Network is a charitable 501(c)(3) organization, Federal tax ID # is 84-0961159.
I (we) have designated Colorado Health Network in my (our) will/estate planning.
I (we) would like more information about including Colorado Health Network as a beneficiary in my will, insurance, IRAs, etc. (IRA distributions annually can be donated, up to $100,000, tax-free to 501 (c)(3) charities.
Donor Signature

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Pledge Form

Donor Information

Gift Information

Recognition Information

Payment Information