thank you for your support pledge form
TRANSCRIPT
For assistance and for information on recognition, please contact [email protected] or call +1.630.203.3836.
Thank you for supporting Lions Clubs
International Foundation (LCIF) and
Campaign 100!
for all Campaign 100 donations
Pledge Form
Thank You for Your Support
In add
ition to receiving Cam
paign 100 recognition, your contrib
utions throughout Cam
paign 100
qualify for ad
ditional M
elvin Jones Fellow recognition. C
omm
itments of every size m
ake a big
imp
act over time. H
ere’s how:
Cam
paig
n 100R
ecog
nition
Level
Pled
ge
Am
ount
(US
$)
Annual
Co
ntributio
n(U
S$)
Mo
nthly C
ontrib
ution
(US
$)
$25,000+$5,000
$417
$15,000$5,000
$417
$5,000$1,667
$139
$2,500$833
$69
$1,000$333
$28
$600$200
$17
$300$100
$8
CA
MPA
IGN
D
ON
OR
PIN
...yours w
ith a U
S$100 donation!
C042_CA1_EN_US 10/19
Email a copy of your receipt or wire transfer form – along with your name, member ID, club name, and district name – to [email protected]. If requesting recognition, please include the recipient’s name, member ID, club name, and district name.
Local Bank DepositLions Clubs International has accounts at local banks in several countries. Find a list of banks at which donations may be made at lionsclubs.org/paymentbycountry. Email a copy of your deposit receipt – along with your name, member ID, club name, and district name – to [email protected]. If requesting recognition for someone else, please include the recipient’s name, member ID, club name, and district name.
Transfer of StockTo transfer stock or other securities, use the instructions and form found at lionsclubs.org/waystogive.
Wire TransferTo transfer funds to LCIF, present the information below to your bank, along with local currency funds covering the amount of your donation and applicable bank charges.
How to DonateSeveral methods are available to support LCIF and Campaign 100.
ABA Routing Number: 021000021Account Name: Lions Clubs International FoundationAccount Number: 754487312Swift International Banking Number: CHASUS33
JPMorgan Chase Bank, N.A.10 S. Dearborn St.Chicago, IL 60603 USA
I pledge a total contribution of US$____________________________________ to LCIF.
My first payment, US$________________, will be made by_________________________.
PLeDge InFormaTIon
Campaign 100 Pledge Form
For pledge recognition and recording purposes, please provide the following information:
Donor InFormaTIon
Name (print clearly) ________________________________________________________________________
Address _________________________________________________________________________________
City _____________________________________________ State/Province __________________________
ZIP/Postal Code __________________________________ Country _______________________________
Email ____________________________________________ Phone _________________________________
Member ID _______________________________________________________________________________
Club Name _______________________________________ District Name ___________________________
o Please keep my personal and donation information anonymous. I understand my club/district (if any) may receive recognition for my donation.
Signature Month/Day/Year
Pledges of US$25,000+ are payable over five years; pledges of US$1,000+ are payable over three years. If no payment frequency is selected, LCIF assumes equal annual installments based on pledge amount.
o VISA o MC o AMEX o Discover
Card # ______________________________________________________ Exp. Date (mm/yy) _____________________
Name on Card _______________________________________________ Security Code _________________________
* Donate securely at lionsclubs.org/change or provide:
o Check o Wire Transfer o Credit Card*/PayPal
PaymenT FrequenCy (choose one)
PaymenT meThoD (choose one)
All donations toward fulfilling Campaign 100 pledges receive Melvin Jones Fellow credit!
Month/Day/Year
Your pledge form is at right. Please return your completed form by either:
n email: Scan and send to [email protected]
n Postal Service: Lions Clubs International Foundation | Department 4547 Carol Stream, IL 60122-4547 USA
If including your initial payment with the form, please follow instructions above.
o monthly My monthly payment is to be US$______________
o annuallyMy preferred annual payment is US$______________
o all at once
Lions Clubs International FoundationDepartment 4547Carol Stream, IL 60122-4547 USA
CheckSend US$ checks, payable to LCIF, to:
Credit Card or PayPal Donate securely at lionsclubs.org/change.
Complete your Pledge Form Today!
!
!