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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]