Pledge Form

Identification

Name:

Address:

Telephone:

Email:

In Memory of:

Pledge

Total Amount:

$25

Payment Schedule:

	A Lump Sum
	Monthly Payments

I intend to complete my donation by:

	December 31,2010
	December 31,2011
	December 31,2012
	December 31,2013
	December 31,2014

Method of Payment:

	Cash
	Cheque (Post-dated and payable to: St. Joseph the Worker Parish Building Fund)
	Visa
	Mastercard
	PAD: Pre-Authorized Monthly Donation

NOTES: Please contact the parish office to confirm payment arrangements. Should your circumstances change, you may modify your pledge at any time. This
pledge is made in addition to your regular weekly offering to St. Joseph the Worker Parish.

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St Joseph’s Building Fund Pledge Form

Identification

Pledge