Donor Commitment

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Donor Commitment Form

Interest in or Pledge For:(Required)

Name of Business / Organization

Preferred Contact Name(Required)

First Last

Preferred Contact Email Address(Required)

Enter Email Confirm Email

Name that should be used in print recognition, if desired

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone(Required)

Additional Phone

Organization Website

Organization Social Media

Please provide username(s) or link to profile(s)

Name

Attorney / Financial Advisor Company

Attorney / Financial Advisor Phone Number

Recognition for Donation(Required)

Check all that apply

Donor wishes to remain anonymous

Donor agrees to be recognized for the gift/commitment in ways such as advertising, print materials, and news releases

Donor agrees to the use of company logo in recognition of donation to Clarity

Pledge:

This organization would like to make a contribution of the following amount to Clarity of Central Indiana:

Single Payment of:

Initial Payment of:

Pledge Payment Period:

In years, up to 2 years.

Frequency of Payments:

Monthly

Quarterly

Semi-Annually

Annually

With payments of:

Beginning on:

Payment Method(Required)

Payable to Clarity of Central Indiana. Asset or stock transfer instructions will be provided upon commitment.

If In-Kind Gift, please specify:

Are there other parties that need to be made aware of this gift or involved in its transaction?

If so, please identify whom and next steps:

Additional Comments

Note: An official charitable receipt will be issued upon receipt of donation.

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