Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Payment Frequency *

I/We anticipate making payments...

One Time

Monthly

Quarterly

Annually

Payment Start Date *

It is my/our intent to begin making payments beginning on date:
(Unless a future date is specified, we hope to receive gifts or installments within 30 days of a pledge being submitted.)

MM

DD

YYYY

Anonymity

I wish to remain anonymous.

Gift Options

I would like to donate by other means such as stock.

I would like to request more information about naming rights opportunities.

I would prefer to make my donation via Credit Card. Please contact me for payment details.

I would like to discuss my options to bequest a gift to Bainbridge Performing Arts.

Employer Match

My employer will match my gift.

Employer Match Contact

First Name

Last Name

Employer Phone

(###)

###

####

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gift Policy Agreement *

I have read and accept BPA's Gift Acceptance Policy Agreement.

I Accept

Accuracy & Terms Agreement *

I/we verify that the information in this form is accurate and true, and I/we agree to uphold the terms of this pledge to its completion.

I Accept