Pledge Card

Billing Information

(Items in red are required.)

Name of person to deliver to:

Address to deliver to:

Confirmation phone number:

Confirmation email:

Person confirming order:

Department:

MO code:

PS acc. #:

*Fiscal contact email:

Special Instructions:

Submission Status/Results:

*This person will also receive order confirmation.

Quantity Information

Pledge Card Quantity: 5,000 Price:

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