ONLINE PLEDGE FORM

The Tomorrow Fund
Rhode Island Hospital Campus
593 Eddy Street
Providence, RI 02903-4947

Phone: (401) 444-8811
Fax: (401) 444-4542
http://www.tomorrowfund.org

YES! I want to make a gift to The Tomorrow Fund!
(For best print out, set browser font size to 10 point then print, complete and return this form.)

This year I'd like to give:

___ $15   ___ $50   ___ $70   ___ $100    $________ (other)

I'd like to make my gift using:

___ One personal check, enclosed.   
___ Post-dated check(s), enclosed.
___ Credit Card ___Mastercard ___Visa___ Discover___ American Express
      Credit Card Number _______________________    Expirate Date _______ Security Code _______
On American Express cards, the security code is  four digits above your account number on the front of the card.
On MasterCard and Visa cards, the security code is the last three digits inside the signature strip on the back of the card.

Please indicate purpose of gift.
___ General Donation   ___ Memorial  ___ In Honor of   ___ Other
Additional Information:______________________________________________________________________

 

   
 
Signature: 
  		_____________________________  Date: ___________
Name: 
  		_____________________________________________
Address: 
  		_____________________________________________
City: 
  		_____________________________________________
State: 
  		________________  Zip Code: __________________
Tel # Home: 
  		( ___ ) ____________ Business: ( ___ ) ______________
E-mail Address: 
  		_____________________________________________
Company Name:  _____________________________________________

(This information allows us to acknowledge corporate campaign participation.)

THANK YOU FOR YOUR SUPPORT

Please make checks payable to: The Tomorrow Fund.
Tax receipts are issued for gifts of $10 or more.