Campaign for Expansion - Make a Pledge

I/We are pleased to make a gift to Packard Health in the amount of $ payable over years, in support of Packard Health's Campaign for Expansion.

I/We would like our gift to be designated to:

Where it is most neededCapital ExpensesProgram Expansion

I/We will fulfill this pledge through:

• A one-time cash payment to be made in (month/year)
• Annual payments of $ to be made beginning
• Monthly payments of $ to be made beginning
• Appreciated securities made in
• Other means (please specify):

Please contact me for credit card information for payment of one-time or recurring pledge payments.

Please recognize my/our gift as follows:

I/We wish to remain anonymous

Donor Name(s):

Address:

City, State, Zip:

Phone:

Your Email

Thank you for your generosity!