1. Pledge Amount

$250          $500         $1,000       Other (please specify amount)

$2,500       $5,000       $10,000      $     

 

 

2. Payment Schedule

Single Payment - One Time Gift

Quarterly Gift (The above pledge amount will be divided into 4 equal payments)

Semi-Annually Basis (The above pledge amount will be divided into 2 equal payments)

 

 

3. Gift Designation

This gift is in honor/memory of:
     

       Use my gift:

                   Where the need is greatest

               Other (please specify):
                   

4. Your Billing Information

First Name                                                          Last Name
          

Address

City

State                                                                   Zip
           

Daytime phone                                                     E-mail Address
           

5. Payment Method
Visa           Mastercard          American Express
Credit card account No.:                   Expiration:
             

Please send me information on naming Mercy in my will.

You have one more screen to confirm your gift contribution.