Pledge Form
St Mary’s DSG, Kloof
Service before Self, God before All
Donor Information (please print or type)
Name
Billing address
City
State
Postal Code
Telephone (home)
Telephone (business)
Fax
E-Mail
Pledge Information
I (we) pledge a total of $ /€ /£ /R _______________ to be paid:
____now____ monthly ____ quarterly ____ yearly.
I (we) plan to make this contribution in the form of:
____cash____ cheque ____ credit card ____ other.
Credit card type
Credit card number
Expiration date
Authorized signature
Gift will be matched by________________________________company/family/foundation).
____form enclosed ____ form will be forwarded
Acknowledgement Information
Please use the following name(s) in all acknowledgements:
____ I (we) wish to have our gift remain anonymous.
Signature(s)
Date
Please make cheques, electronic financial transactions, or other gifts payable to:
[St Mary’s DSG, Kloof] St Mary’s DSG, Kloof
[P O Box 178] Nedbank Branch No. 164 826
[Kloof, 3610, South Africa] Account number 1648 180523
[Tel: +27 31 7649800] [Fax: +27 31 7640011]
admin@stmarys.kzn.school.zawww.stmarys.kzn.school.za