Restoration Pledge Form

Gift Commitment/Pledge Form
Donor(s) Name(s)
i.e. "Becky and Gary Smith"
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Gift Commitment
Will you be making a one-time gift or pledging to pay your commitment over time?
Gift Commitment Total $
One-time gift amount or total pledge. No commas or decimals, please.
Giving schedule for pledge/installments for a three-year pledge
Number of installments
Amount of each installment $
When will you submit your one time gift or begin paying pledge installments?

MonthDayYear
Approximate dates are accepted.
Payment Details
Payment method
Please see your email confirmation for details about paying your gift/pledge installments through your DAF.
Please see your email confirmation for details about paying your gift/pledge installments with a check.
Bank Routing number
Account number
Name on card
Card number
Exp. Date

MonthDayYear
Date
CV/CVC code
I will cover the card processing fee.
Gift Recognition
Gift recognition permission
Name as you’d like it to appear
Comments
Please use this space for clarification or comments about your gift or pledge.
Signature
Signature
Date

MonthDayYear
Date
Should be Empty:

Gift Commitment/Pledge Form