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MEMORIAL CHURCH

 

TAX DEDUCTIBLE PLEDGE RECORD SHEET

√PLEASE PRINT√ 

NAME :______________________________________________

 

ADDRESS :_________________________________________________

 

CITY :_________________STATE :____________ZIP :_____________

 

AMOUNT OF PLEDGE / CONTRIBUTION:$___________

 

ONE TIME CONTRIBUTION?_____

 

MONTHLY?____

 

YEARLY?_____

 

This is for the purpose of sending you a receipt and to have a record of your intentions. 

The information WILL NOT BE GIVEN OUT UNDER ANY CIRCUMSTANCES.

 

Thank you, for your interest in MEMORIAL CHURCH, and for your generous contribution.

Please print out and send, filled in, with your check or money order to:

MEMORIAL CHURCH
   2338 East 5TH ST

Dayton, OH 45403