Pledge Form - Shelterhouse

Pledge Form
Donor Information (please print or type)
Billing Address
City, State Zip Code
Phone Number
Email Address
Pledge Information
I pledge a total of $____________________ to be paid: ☐Now ☐Monthly ☐Quarterly ☐Yearly.
I plan to make this contribution in the form of: ☐Cash ☐Check ☐Credit Card ☐Online via PayPal.
Designate My Donation to This Fund:
Credit Card Number | CCV
Billing Zip Code | Exp. Date
Authorized Signature
Gift will be matched by (company/family/foundation)
Acknowledgement Information
Please use the following name(s) in all acknowledgements:
☐I wish to have my gift remain anonymous.
Please make checks, corporate matches,
or other gifts payable to:
3115 Isabella Street
Midland, Michigan 48640