IMPACT Emanu-El Donation Form

First Name

Last Name

I/We would like to make a pledge to the Impact Emanu-El Fund.

To make the most generous gift possible, please consider making a gift over multiple years.

My/our pledge is

Other Amount

Amount

I/we would like to pay by

I/we would like to make a courtesy contribution of 3% to offset processing fees

Pay this in installments?

Gift+Processing Fee

Payment Start Date

Frequency of Payments

I/we want to pay over the following number of years:

I/we would like to pay on the following payment schedule:

Number of Installments

Gateway Schedule

Installment Payment Amount

Payer Information

Payer First Name

Payer Last Name

ACH/eCheck Billing

Account Holder Name

Bank Name

Bank Account Number

Bank Routing Number

Bank Account Type

Credit Card Information

Credit Card Number

Exp. Month

Exp. Year

Verification Code

Billing Street

Billing City

Billing State

Billing Zip Code

I/We would like my/our name(s) to appear in public acknowledgements as:

Anonymous

Would you like to make this gift a tribute in honor/memory/celebration/observance of a yahrzeit of someone?

Honor/Memorial

Type

Recipient Name

Is the tribute recipient a member

Occasion

Person to Notify

Notification Address

City

State

Zip Code

Please contact me/us about a matching employer gift

Yes

Please contact me/us about making a legacy gift to Congregation Emanu-El.

Yes

Hidden Fields

Authnet_Hidden_Fields

Quantity for One-time scheduled payments

Quantity for Installments

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