Capital Campaign

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Financial Gift
Pledge Total Amount:*
We wish to spread our gift equally over a ____ year period*
Initial investment enclosed
Please accept the remaining balance by payments made:
- Monthly
- Quarterly
- Semi-annual
- Annual
The anticipated amount of each payment toward my/our total campaign gift is
beginning on this date
MM slash DD slash YYYY
(Please make checks payable to LCCEF, noting campaign in the memo area.)
I would like to set up payment of my pledge through using appreciated stock. Please call me at (daytime phone number)
Please do not publish my name in recognition materials.
- I/we prefer to remain anonymous.
Signature

Financial Gift