Thursday, 07 January 2016 14:57

OASIS PLEDGE FORM

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PLEDGE FORM:  Victoria General Hospital Auxiliary’s Oasis Campaign

 

Individual Giving

Your Name:___________________________________________

Home Address:________________________________________

Phone Number:________________________________________

Email:________________________________________________

 

Corporate Giving

Company Name:_______________________________________

Address:______________________________________________

Your Position:_________________________________________

Key Company Contacts:_________________________________

Preferred Email:_______________________________________

 

Pledge Information

Pledge Amount Minimum: $________________

Pledge for Contract Value: $_______________

Describe Your Commitment:_________________________________________________________

 

Your gift is due on May 1, payable by cheque to the VGH Auxiliary and sent to the Auxiliary at Victoria General Hospital. Pledges made after this date will be due and payable on the first day of the ensuing month.

 

Payment Method:

 Master Card    

 Visa   

 Cheque   

 Stock

Name on Card:__________________________________________

Credit Card Number:_____________________________________ 

Expiration Date:_________

Signature:______________________________________________

Issue receipt in the name of:______________________________

 

 I/we prefer this gift to remain anonymous

 I/we wish to be recognized as _____________________________________________

 

Notes or comments:_____________________________________________________________

 

Everyone using the Oasis thanks you for making this project possible.

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