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Capital Campaign
Help MOM reach our goal of raising $500,000 to secure its future operations!
Make a pledge or donation to the Capital Campaign today!
Pledge and Donation Information
Pledge Amount
*
This gift is payable over:
*
1 year
2 years
3 years
I/We will make payments:
*
One Time
Monthly
Quarterly
Annually
Pledge Payments will begin:
*
(mm/dd/yyyy)
Method of Payment
*
Check - Mail to 5741 Carmichael Parkway, Montgomery, AL 36117
Credit Card - Complete donation information below.
Stock - MOM will contact you with transfer instructions.
Pledge Payment Paid Via Credit Card Today
$1,000
$500
$100
$50
$
Recurring Credit Card Payment Schedule
One Time
Monthly
Quarterly
Yearly
Continue donating until
(mm/dd/yyyy)
Donor Instructions
Donor Name for Acknowledgment
*
Print exactly as you would like it to appear.
I/We prefer this gift to remain anonymous.
*
Please consider listing your name as an encouragement to others to give.
Yes
No
This gift will be matched by:
Company Name
Is this donation in honor or in memory of someone?
*
No
Yes, in honor
Yes, in memory
Name of person gift is in honor of:
Name of person gift is in memory of:
Contact information for person to be notified of gift:
Include any special information or instructions for acknowledging the gift.
Special Instructions:
Donor Information
Name
*
Prefix
First Name
Last Name
Suffix
Organization/Employer
If corporate gift
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Phone
*
Add 3% to my total amount to help cover processing fees (for credit card payments only)
