FUND FOR SOUTHERN COMMUNITIES DONATION FORM

Please fill out the following form and send it along with your donation to:

Fund for Southern Communities
315 West Ponce De Leon Ave Suite 1061
Decatur, GA 30030


I would like to support the Fund for Southern Communities with a donation today of:

______$10,000   ______$5,000    _____$600  _____$240    _____$60   _____Other

____ A check is enclosed
____Bill my credit card
____I would like my gift to be anonymous

I would like to make an annual pledge of:
______$10,000   ______$5,000    _____$600  _____$240    _____$60   _____Other

Enclosed is my first payment of $_______
After my first payment, bill me:
____By mail        ___Charge my credit card
       ?Monthly		?Bi-Annually
       ?Quarterly		?Other

Please bill my:
?Visa			?Mastercard
?American Express 	?Discover
?Other

Account #____________________________
Expiration Date _______________________

Signature____________________________

I would like to:
____Make a stock Gift		____Open a Donor-Advised fund
____Learn about Planned Giving	____Learn more about FSC
____Host a House Party		____Volunteer

Your Name __________________________________
Address _____________________________________
City__________________ State ______  Zip ________
Telephone:  Work (___) ____________   
Home (      )____________
Email Address ______________________

____ I have a friend, family member or coworker that I want to challenge to match my gift
FSC will send them information about our program as well as a request from you for them to match your gift.  
 	
	Their Name ________________________________
	Address ___________________________________
	City ________________ State _____   Zip _______
	Telephone (       )___________________  Email Address ___________________