Gift and Pledge Form
A c h i e v i n g t h e D r e A m
Donor Information
Donor Name(s): _____________________________________________________________________________________
Address: ____________________________________________________________________________________________
City: _________________________________________ State: ______________ ZIP: _____________________________
Phone: _________________________ Cell: ________________________ Email: ________________________________
Gift/Pledge
☐ I approve the use of my name in a published list of donors. ☐ Do not use my name in a published list of donors.
Total Amount of Gift or Pledge: $ _________________________
☐ Area of greatest need ☐ General Scholarships
☐ Book Scholarships ☐ Other (please specify) _____________________________________________
☐ One-Time Gift
☐ Pledge Period: __________years Payments of: $ ____________ will begin on _______________ (date) and continue
☐ Monthly ☐ Quarterly ☐ Semi-Annually ☐ Annually
Payment Options:
☐ Check made payable to COM Foundation
☐ Visa or ☐ MasterCard
☐ Billing address same as above or
Address: __________________________________________________________________________________
City: __________________________________State: ______________Zip: ____________________________
Card Number: __________________________ Exp. Date: _______ Name on Card: _____________________________
Please charge each pledge payment to the credit card provided above: ☐ Yes ☐ No
Gift Information
☐ This gift is given ☐ in memory of or ☐ in honor of: _____________________________________________________
☐ This gift is eligible for a matching gift by: _____________________________________________________________
Company Name (please include form)
Planned Giving
☐ I am thinking about including COM in my will or estate plan. I would like someone to call me with more information.
☐ I have already included COM in my will or estate plan.
______________________________________________________________________ ________________________________
Donor(s) Signature(s) Date
Please return to: College of the Mainland Foundation, 1200 Amburn Rd., Texas City, TX 77591 or fax to (409) 933-8041.
For more information, please call (409) 933-8508.
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