Rebuild My Church Online Pledge Form

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First Name *

Last Name *

Spouses First Name

Spouses Last Name

Address *

City *

State *

Zip Code *

Primary Phone Number *

Primary Email *

I/We pledge the amount below to the Rebuild My Church campaign (Total pledge paid over three years) *

My gift will be matched by my company (enter company name below)

I/We intend to pay the balance as follows: *

Monthly

Quarterly

Semi-annually

Annually

One time

Other:

I/We prefer to pay our pledge via *

Cash/check (make payable to St. Francis of Assisi and indicate Rebuild My Church in the memo section)

Credit Card

Automatic Withdrawal

Stock (contact the parish office for this payment option)

Life Insurance (contact the parish office for this payment option)

Other:

Date of First Payment *

YYYY

Signature (Type Name Below) *

Today's Date *

YYYY

Please Note:

Please note that this form does not submit your payment but rather informs Pat Burns, Director of Stewardship and Finance, of the intent of your pledge. Pledge amounts are kept confidential.

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