Name:

Are you pledging with your spouse? No Yes

Do you want giving envelopes? No Yes

Street Address:

City:

State:

ZIP Code:

Phone:

E-mail Address:

Total Annual Commitment:

Payment Schedule: Choose one... Weekly (52) Bi-Weekly (26) Semi-Monthly (24) Monthly (12) Bi-Monthly (6) Quarterly (4) Semi-Annual (2) Annual (1)

Would you like us to mail you a form for direct deposit? Yes No

If the church will receive a contribution from a charitable organization or source other than yourself, please list name: