NEW Heroes of Hope Pledge Form

Please select a pledge type:

Join Legacy of Hope Giving Society Multiple Year Pledge Existing Donor(s) with a Pledge

If you would like to contribute a one time gift or monthly donation, please go to https://cancercareservices.org/give/ and click the "Give" button at the top.

I/We would like to join the Legacy of Hope Giving Society at:

$1,000 per year for 5 years ($84 per month) $1,500 per year for 5 years: totaling $7,500 to celebrate 75 years of service! $10,000 per year for 5 years $25,000 per year for 5 years Other amount per year for 5 years (select to enter amount)

I/We would like to contribute yearly at $____ for 5 years:

Minimum contribution of $1,000 to become Legacy of Hope Giving Society

Contribute yearly at $:

Contribute the above yearly amount for ___ years:

Please tell us how you would like to support Cancer Care Services today:

Pay off the full pledge balance today, and begin a new pledge Increase or extend the existing pledge Pay this years pledge amount today

New pledge $ amount:

Number of years pledged:

Increase existing pledge by $____/year:

Example: Increase existing pledge $500/year for remaining pledge years

Extend existing pledge by number of years:

Please select how you would like to make your payment(s):

I will mail a check - made payable to Cancer Care Services Please contact me about paying via auto-draft (ACH/EFT) Please contact me about paying with stock or with Qualified Charitable Distributions (QCD), Donor Advised Funds (DAF), or workplace giving/payroll deduction Please charge my credit card (select to enter information)

Make a payment today: *

USD This is a one-time payment. Please make note in the Comments box if you would like to set up automatic pledge payments.

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Today's Date *

Date

Name(s) *

First Name Last Name

Email *

example@example.com

Phone Number *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

May we publicly recognize your name and/or gift?

Yes Do not display my name Do not display my gift

Questions, Comments, Thoughts to Share:

We will remind you on May 1, 2021 of your annual pledge through a mailed statement, unless otherwise requested.

Donor Signature *

Clear

Cancer Care Services

623 S. Henderson

Fort Worth, TX 76104

Heroes of Hope Pledge Form

Multiple Year Pledge

Existing Donors with a Pledge:

Payment Information

Donor Information