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: ________________________________
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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