Capital Campaign Pledge Form | Fort Defiance Humane Society

Capital Campaign Pledge Form

Donation form for the Capital Campaign

Please Print the name(s) as you wish to be acknowledged for your pledge:(Required)

Company/Organization

Address(Required)

Street Address City State ZIP Code

Email(Required)

Enter Email Confirm Email

Phone(Required)

I/We would like to pledge this amount to FDHS:(Required)

I/We intend to make this pledge payment over

I/We would like to make payments via(Required)

Please specify your expected payment schedule.

Gift Options (select all that apply):

I/We would like to set up automatic payment/s by credit card. Our staff will contact you to obtain card info.

I/We are interested in a gift of stock securities, IRA charitable transfer, or other form of gift. Please contact us at the information listed on the Contact page

I would like to discuss commemorative/naming opportunities available in the campaign

I would like to receive pledge reminders.

This gift is in honor / memory of:

My/Our gift is eligible to be matched by:

Donor Signature(Required)

Date(Required)

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