Giving Tues Match Form — Sustainable Health Empowerment

Giving Tuesday Matching Challenge Pledge Form

I/We pledge to donate, joining other individuals or companies in creating a matching fund challenge as part of Sustainable Health Empowerment’s Giving Tuesday campaign on December 3, 2019. I/We understand that this amount will be charged to the credit card indicated below as one lump sum on December 3 or in twelve monthly increments, if preferred.

Name

First Name

Last Name

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Credit Card Issuer

Credit Card Number

Exp Date

CCV

Amount to be charged:

Payment option

Single payment

12 Monthly payments

Please acknowledge me/us by

Logo on SHE Website on Giving Tuesday

Name on SHE Website on Giving Tuesday

I/We prefer to make this gift anonymously

Giving Tuesday Matching Challenge Pledge Form

© sustainable health empowerment

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