Multi Payment Pledge

Donors will be recognized alphabetically in campaign materials unless an anonymous gift is requested.

First Name *

Last Name *

Address *

Address Line 1

City

State / Province / Region

Zip / Postal Code

Home Phone

Cell Phone

Business Phone

Email *

I/We pledge a total of $

I/We wish to have this donation spread over:

If Other:

Please send pledge payment invoices to me beginning on:

and thereafter:

If Other:

My gift will be matched by:

Company/Foundation/Family

I/We would like information on including WVMCC in my (our) will/estate planning. (copy)

Donors will be recognized alphabetically in the campaign materials unless an anonymous gift is requested.

Please use the following name(s) in all acknowledgments

Please keep my gift anonymous

Signature *

(Please type name)

Date *

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