NAME

Parish Member # 

ADDRESS

CITY   STATE   ZIP

PLEDGE AMOUNT  $

Check One:     Pay in Full       Pay Over 3 Years

I/We will send My/Our Pledge in to the parish office 

Charge or Debit my Account  $

Weekly    Monthly    Quarterly    Annually 

Bank Routing #   Bank Account #

or

Credit Card:  Credit Card #

Name on Card      Exp Date: 

Credit Card Billing Address 

CITY   STATE   ZIP

Signature_____________________________________

I Can Provide The Following Service In-Kind For The Building