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Heroes of Hope Pledge Form
Please select a pledge type:
Join Legacy of Hope Giving Society
Multiple Year Pledge
Existing Donor(s) with a Pledge
I/We would like to join the Legacy of Hope Giving Society at:
$1,000 per year for 5 years ($84 per month)
$5,000 per year for 5 years
$10,000 per year for 5 years
$25,000 per year for 5 years
Other amount per year for 5 years (select to enter amount)
I/We would like to contribute yearly at $____ for 5 years:
Minimum contribution of $1,000 to become Legacy of Hope Giving Society
Multiple Year Pledge
If you would like to give outside of the Legacy of Hope Giving Society please see below:
Contribute yearly at $:
Contribute the above yearly amount for ___ years:
Existing Donors with a Pledge:
Thank you for your prior pledge! Please tell us how you would like to support Cancer Care Services today:
Please tell us how you would like to support Cancer Care Services today:
Pay off the current pledge balance today, and begin a new pledge
Increase or extend the existing pledge
Add more year(s)
Pay my current annual pledge amount today
New pledge $ amount:
Number of years pledged:
Increase existing pledge by $____/year:
Example: Increase existing pledge $500/year for remaining pledge years
Extend existing pledge by number of years:
Payment Information
Please select how you would like to make your payment(s):
Please contact me about paying via auto-draft (ACH/EFT).
Please charge my credit card (select to enter information).
I will mail a check - made payable to Cancer Care Services.
Contact me about paying with stock, Qualified Charitable Distributions (QCD), Donor Advised Funds (DAF), payroll deduction, or company matching.
Credit Card Information
Name
As it appears on the credit card
Credit Card Number
16 digit
Expiration Date
mm/yy
Security Code
Three digit number on the back of the card
I would like to give:
Monthly
Quarterly
Annually
Is the billing address different from the mailing address?
*
Yes
No
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Donor Information
Today's Date
*
-
Month
-
Day
Year
Date
Name(s)
*
First Name
Last Name
First Name
Last Name
Email
*
*To stay informed with Cancer Care Services updates, your email will be added to our e-newsletter list.
Phone Number
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
May we publicly recognize your name and/or gift?
Yes
Do not display my name
Do not display my gift
Questions, Comments, Thoughts to Share:
Donor Signature
*
Clear
Cancer Care Services
623 S. Henderson
Fort Worth, TX 76104
Submit
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