El Paso Lighthouse for the Blind
Cash Donation - Pledge Form

- For a cash donation, please complete Sections 1,2, and 4.
- For a pledge, please complete Sections 1,2, and 5.
- Please complete section 3 if your donation or pledge is made in memory of or in honor of someone.
- Please include your Signature and date if you complete Section 5.

Section 1 - Donor Identification

Name ____________________________________

Address __________________________________

City, State, Zip ______________________________

Home Phone ( ) _____________  Business Phone ( ) _____________


Section 2 - Designation

This tax deductible gift is:

_____ Unrestricted (for use where the need is the greatest).

_____ Restricted to use in the _________________________________.
                                             (program or service)


Section 3 - Memorial or Honor Gift (optional)

This gift is (in memory of) (in honor of):

___________________________________

Relationship to person named _____________________.

Names and addresses of persons to be notified of this gift:

______________________________________________________________________

______________________________________________________________________


Section 4 - Gift Information

I have enclosed a gift of $____________________.


Section 5 - Pledge Information

I pledge a gift of $_____________ payable in ( ) annual ( ) semi-annual
( ) quarterly ( ) monthly installments for ________ years.

I have enclosed the first installment.

__________________________________ _____________
Signature Date