SAMARPAN TEMPLE AND COMMUNITY CENTER

Pledge Form

Donor Information

Pledge Information

I (we) pledge a total of $ to be paid: one timemonthlyquarterlyyearly.

I (we) plan to make this contribution in the form of: cashcheckcredit cardother.
Gift will also be matched by (company/family/foundation)

Acknowledgement Information

Please use the following name(s) in all acknowledgements:
I (we) wish to have our gift remain anonymous (Anami).