7/25/2019 donasi Form.docx

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donasi Form[Organization Name]

[Mission Statement]

Donor Information (please print or type)

Name

Billing address

City, S !ip Code

"#one $ % "#one&

Fa' % mail

"ledge Information

I (e) pledge a total of *++++++++++++++++++++ to e paid- nomont#ly./arterly

yearly0

I (e) plan to ma1e t#is 2ontri/tion in t#e form of- 2as#2#e212redit 2ard ot#er0

Credit 2ard type % 'p0date

Credit 2ard n/mer

3/t#orized signat/re

4ift ill e mat2#ed y (2ompany5family5fo/ndation)

form en2losedform ill e forarded

321noledgement Information

"lease /se t#e folloing name(s) in all a21noledgements-

I (e) is# to #a6e o/r gift remain anonymo/s0

Signat/re(s) Date

"lease ma1e 2#e21s, 2orporate mat2#es,or ot#er gifts payale to-

[Organization Name][Street 3ddress][City, State !I" Code]