SHUVU Donation Form - Form

Temple Israel Campaign Pledge Form

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Zip

* Preferred Phone

* Email

* Method of Payment:

* Credit Card Convenience Fee:

Please Select OneIncludeDon't Include

Terms of Pledge

* Total Amount of Pledge:

* Pledge to be paid as follows:

Please Select OnePay with single paymentPay pledge over 1 yearPay pledge over multiple years

Single Payment Amount

Single Payment Date

Recurring Payment Amount

Beginning on (date):

Recurring Payment Amount:

To begin on (date):

To be paid over (years):

Pledges greater than $5,000 may be paid over five years time.

Please enter how often you would like to be billed:

Public Recognition

* Temple Israel may publicly acknowledge my commitment

* Please list how you would like your name to appear in recognition

For gifts over $5,000: Please indicate if you want to be contacted for naming opportunities

Please Select OneYes, please contact me about naming opportunitiesNo, I don't want to be contacted about naming opportunities

This gift commitment is made in honor/memory of:

Please send notification of my honorary/memorial gift to:

Please include name, address, city, state, zip and any special instructions.

Additional notes:

By this pledge, I/we are making a binding commitment to give the amount(s) specified, which pledge Temple Israel accepts and will act in reliance upon to begin the building and renovation project at 3100 E. Broad Street Columbus, Ohio 43213. I/we intend that the terms of this pledge be legally binding and enforceable against me/is and my/our respective successors and heirs (including without limitation, my/our estate(s) and executor(s)). This pledge shall be governed by and interpreted under the laws of the State of Ohio. Temple Israel is a not-for-profit, tax-exempt organization under the provisions of section 501©3 of the Internal Revenue Code. Temple Israel’s federal tax identification number is 31-4384145. Donations are tax-deductible to the extent allowed by law.

* Donor Signature

* Date