Name
*
Date
Address
*
City
*
State
*
Zip
*
Your email Address
*
Phone Number
*
Decision
*
Amen! I/We have already made a gift to the campaign.
Yes! I/We agree to make a pledge today.
Praying! I/We are still praying about our commitment. (
Followup phone call please
.)
No. I/We are unable to participate.
Timing
Monthly
Quarterly
Semi-annually
Annually
Type of payment
*
Auto-debit (followup required)
Check
Stocks/Bonds/etc
Start Date of Pledge Payments
(month/year)
*
In support of
Raise These Walls
, I/we pledge the following:
$5,000/year for 5 years (
Total gift of $25,000
)
$200/month for 60 months (
Total gift of $12,000
)
$150/month for 60 months (
Total gift of $9,000
)
$100/month for 60 months (
Total gift of $6,000
)
$50/month for 60 months (
Total gift of $3,000
)
$40/month for 60 months (
Total gift of $2,400
)
$30/month for 60 months (
Total gift of $1,800
)
Other (
Followup phone call please
.)
Total Pledge
*
Security Code
*