Donor Name:_____________________________________________________
Address:________________________________________________________
City/State:__________________________________Zip:__________________
Phone:(......)_____________________________
E-mail:_________________________________
Please accept my/our pledge for the Fredericktown Community Center.
Total Gift Amount:________________________________________________
Is your gift to be extended over 3 years? YES... NO (please circle)
A gift of $10,000.00 or more may be extended over 5 years. Do you wish to extend
your pledge over 5 years? YES.....NO (please circle)
If your gift is to include a Permanent Naming Opportunity, please indicate below.
_______________________________________________________________
You may select from the following to submit your gift:
Fredericktown Community Center Project..........................Fredericktown Foundation
PO Box 86...............................................or......................PO Box 8
Fredericktown, Ohio 43019...............................................Fredericktown, Ohio 43019
Should you have questions, you may call or e-mail:
Scott C. Smith
Fundraising Chairman
740-694-2853