The document is a pledge form for a capital campaign for the Fryeburg Community Center. It asks for contact information and a pledge amount to be paid over 1, 2, or 3 years. Donors can choose different giving levels like Gold, Silver, Bronze clubs. The form collects payment details and has spaces for a signature and first installment.

1. Fryeburg Community Center
Capital Campaign Thank You for Your
Pledge Form Support!
Name:
Mailing Address:
Town: State: Zip:
Day Phone: Evening Phone:
Cell Phone: ( ) Email:
Gold Club………………………...$10,000 and up
Please pint your name as you wish it to
Silver Club…………………..……$5,000 - $9,999 appear on our Recognition Wall.
Bronze Club……………………...$2,500 - $4,999
Senior Club……………………....$1,000 - $2,499 Print Name
Junior Club………………………..$500 - $999
Youth Club…………………...…..$100 - $499 Check box if you prefer to
keep your gift anonymous.
Friends and Neighbors Club…....$25 - $99
Credit Card:
Mastercard Visa American Express
Account Number
Expiration;
You are authorized to charge my credit card at each interval indicated at the bottom
of this form.
Notify me each time pior to charging my credit card.
Signature: Date:
This pledge is for a total amount of: Payments will be made by
To be paid in 1 Year
2 Years Check Credit Card
3 Years
The first installment of $ is included.
Signature:
The Fryeburg Recreation Department Inc., is a tax-exempt 501c3 organization. Mail form to Brad Littlefield
PO Box 41, Fryeburg, ME 04037 Phone (207) 935-3195 bradandtina@roadrunner.com