* = Required Field

First Name  *                                  Last Name *
         

Spouse First Name                          Last Name  (if this is a family pledge)
       

Address Line 1 *

Address Line 2

City *                                                  State *       Zip *
                

Home Telephone                Cell Phone (if applicable)
               

Email Address *

My/Our total pledged gift for 2009   (January 1-December 31) is: *

I/We choose to pay this amount in: *

Weekly installments
Monthly installments
Quarterly installments
One installment

"Would you like to continue receiving church donation envelopes?"    Yes  No

Today's Date: *
 
 
Comments or Questions:

Please remember your commitment may be modified at any time by contacting Rita, our Financial Administrator at (843) 766-5596   or .