Pledge Campaign

Donor Name

Company

Address

Phone

Email Address

Donor Recognition Name

Recognition Option: 'In Honour Of:

Anonymous Donation Anonymous Donation I wish to remain anonymous

**Name on Tax Receipt

Gifting Levels Gifting Levels Platinum $25,000 - $5000/yr annually, up to the next 5 years Diamond $12,500 - $2500/yr annually, up to the next 5 years Gold $7,500 - $1500/yr annually, up to the next 5 years Silver $5,000 - $1000/yr annually, up to the next 5 years Bronze $2,500 - $500/yr annually, up to the next 5 years Copper $1,500 - $250/yr annually, up to the next 5 years Friend $500 - $100/yr annually, up to the next 5 years

Partner with Us Partner with Us Founding Partner $25,000+ one time start up donation, paid in full in 2024 Platinum Hope Donor $50,000+ one time or $15,000+/yr annually, up to 5 years

Payment Terms Payment Terms I will pay my full pledge amount in one payment. I would like to set up annual payments for my pledge amount.

Payment Options Payment Options Cheque: I will mail or drop off a cheque payable to Southeast Cancer Support Services Inc. Credit Card: please contact me for credit card information for this donation

As agreed between the Donor and Southeast Cancer Support Services: I will fulfill my commitment of the above donation amount/annual term pledge plan. As agreed between the Donor and Southeast Cancer Support Services: I will fulfill my commitment of the above donation amount/annual term pledge plan. I agree