Last Name
|
|
First
Name
|
|
|
|
Mailing
Address
|
|
City
|
|
State
|
|
Zip
Code
|
|
Email
Address
|
|
Phone Number
|
Area
Code
Number
|
May we email you from
time to time?
|
Yes
No |
|
|
Pledge
Information |
|
How would you like to
designate your gift?
|
Capital Campaign
An InnVision Program
Unrestricted |
Name of capital campaign
or InnVision program:
|
|
What is your pledged
gift amount?
|
$50
$100
$250
$500
$750
$1,000
$1,500
$2,000
$2,500
$3,000 |
|
Other
|
What is the date would
you like the pledge to become effective?
|
Month /
Day /
Year (mm/dd/yyyy) |
How often do you want
to submit your pledge gift?
|
Monthly
Quarterly (Jan- Mar)
Semi-Annually
Yearly |
|
Other
|
What day of the month
would you like to submit your pledge gift?
|
|
What form of payment
do you intend to use?
|
Check
Credit Card
Cash |
|
Other
|
If you use a credit
card will you be using our Online Donation System?
|
Yes
No |
Would you like to be
notified when pledge gifts are due?
|
Yes
No |
How would you like
to receive your notification?
|
Email
Phone
Letter |
How many days in advance
would you like to receive notification?
|
One Week
Two Weeks |
|
|
Does your employer offer
matching donations ?
|
Yes
No
I Don't Know |
Employer Name (Optional)
|
|
|
|
Comments
|
|
Should
you have any questions contact us by submitting your donation
questions? |