Secure Donor Form

Brighton Memorial Library Capital Campaign
*Required fields colored blue
       
     
    First Name MI Last Name
I (We)     1      
               2

give/pledge to the Brighton Memorial Library Capital Campaign the sum of:

$ total pledge
$ amount submitted today
$ balance payable within years (up to 3 years)
    to be billed: semi-annually   annually

Payment Options

Please charge this gift/pledge on:

Credit Card Number
 

Card Holder Name

  Expires   Month     Year 
   

I would like my gift to be a stock transfer.  Please contact me.
   

To make your gift by check, please print this form and mail it with your check to: Brighton Memorial Library Capital Campaign, 2300 Elmwood Avenue, Rochester, NY  14618
   
Contact Information
   
Address  
   
City   State   Zip  
Phone  
Email  
   
For purposes of recognition, please use the following:
(The inscription can be a maximum of 50 characters and spaces. If you wish to remain anonymous, please indicate.)
   
Please check all boxes which apply to you.
  Trustee 
  Staff Member
  Friend of Brighton Memorial Library
  Board Member of the Friends of Brighton Memorial Library
  Library Card Holder
  Resident of Brighton 
  Other
 

All gifts are tax-deductible as permitted by law.

 

 
 
2300 Elmwood Avenue, Rochester NY 14618
Tel. (585) 784-5300 - TDD (585) 784-5302