Beyteynu Our Home Commitment Form - Form

* First Name

* Last Name

Name

(Please write name(s) on the above line as you would like it/them to appear on all Campaign Materials)

We wish to remain anonymous

* Mailing Address

Apt

* City

* State

* Zip

* Email

* Phone

Option A - One Time Gift

My/our one-time gift is $

Option B - Pledge

In the box below please indicate the total pledge you will be donating. In the next box please indicate the amount of your first payment. Your first payment can be paid either with a credit card on file, entering a new credit, by eCheck online or billing to your account and mailing a check to the office. You MUST be logged into your account to charge (bill) the pledge to your account. Please then let us know how you would like future payments to be handled. If you have any questions please contact Kim Deal at bookkeeper@congregationortzion.org.

I/we will make a total pledge of $

My/our first payment will be $

I/we will continue making equal payments of $

Please choose your payment schedule

Monthly on the 1stMonthly on the 15thQuarterlyAnnually

My/our FUTURE method of payment will be

Credit Card use card on fileCredit Card use updated credit card information beloweCheck onlineBill to my Account and mail checks to the office (make payable to Congregation Or Tzion and add “building campaign” in the memo)

Updated Credit Card Information

Type of card

M/CVisaAmex

Name on Card

Billing Address

Apt

City

State

Zip

Option C - Gift of Stock

You will be contact with instructions about how to make the transfer.

I/we will make a total pledge of $

Option D - I/We intend to recommend a grant from my/our donor advised fund

Name of Fund

Name of DAF Provider

I/we will make a total pledge of $

Donation