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OFFLINE DONATION FORM - Fund4Change_

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					                       OFFLINE DONATION FORM
    This printable form is available for participants to gain pledges offline. Please fill out all the blank
    spaces and make sure that the participant you are sponsoring is listed correctly to be sure that the
                                money is applied to their fundraising goal.

Support the 2013 School Fundraising Drive for Pine Trail Elementary

My Pledge is Sponsoring (Student Name):

           Student Code & Teacher (if known):
Your Name:

Phone:                                            Email Address:

(Vehicle For Change will never sell or distribute your information to any 3rd party. Any information you provide is for the
purposes of this school fundraiser only. You will not be added to any type of mailing lists.)


PAYMENT INFORMATION:
 q Enclosed is my CHECK in the sum of $                                       q Enclosed is my CASH donation
         Please make check(s) payable to:                                            in the sum of $
         Vehicle For Change, Inc.

q Please charge my donation to:
         Check one:                  q Visa     q Mastercard       q AMEX        q Discover

Credit Card Account Number:

Name (As it appears on credit card):

Expiration Date:                     /                       CVC – 3 or 4 digit

Address:                             City:                                 State:              Zip:

Please Note: The address above must match the address that is associated with your credit card.


Please mail this form with payment to:
Vehicle For Change
ClimbOn Challenge Coordinator
511 Coral Trace Blvd., FL 32132

You can FAX this form to:
877.841.5270
Or Donate ONLINE at:
www.fund4change.org

Vehicle For Change is a 501(c)(3) organization
designated by the Internal Revenue Code.
All donations are tax-deductible.
                                                  www.vehicle4change.org
                                         Phone: (877) 841-1110 • Fax: (877) 841-5270

				
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posted:4/17/2013
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