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