Community School · The Next 50 Commitment Form

Name *

First Name

Last Name

Email *

Verify Email *

Contact Information

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Total Commitment *

Please include the total amount of your commitment over a 3 year pledge period.

$5,000

$10,000

$15,000

$25,000

$50,000

$100,000

Other (select appropriate installment amount)

Installment Amount *

$

Installment Schedule

Continue donating until

(mm/dd/yyyy)

Please select amount and frequency of installment. By selecting continue at the end of this form, you will be taken to a payment screen. Your credit card will be charged in regular intervals based on your selected frequency.

Please use the following name(s) in acknowledgments:

I wish to have our gift remain anonymous

Yes

No

When you select Continue, you will be taken to the secure Paypal website, where you may select your preferred method of payment. Your first installment will be processed by Paypal immediately. Should you desire to change your future installment schedule, please contact Development@communityschool.net or the Development Office at 540-563-5036.