Jennings Country Pledge Form Page 2
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1
2Method of Payment
□ Enclosed is a check for $____________, payable to the Jennings County Public Library.
□ Charge my □Visa □Mastercard □Discover
Card #_________________________ Exp. Date___________ CCD#______________
Billing address (if different from mailing address)
______________________________________ City, State, Zip_____________________
□ Electronic Funds Transfer from my checking account
Name on account__________________________________________________
Routing/ABA number_________________Account number________________
Billing address (if different from mailing address)
______________________________________ City, State, Zip__________________
GIFTS OVER TIME – 3 YEARS
Monthly
Quarterly
Annually
Total Gift
$13.89
$41.66
$166.66
$500
$27.78
$83.33
$333.33
$1,000
$69.44
$208.336
$833.33
$2,500
$138.89
$416.67
$1,666.67
$5,000
$208.33
$625.00
$2,500.00
$7,500
$277.78
$833.33
$3,333.33
$10,000
$694.44
$2,083.33
$8,333.33
$25,000
$1,388.89
$4,166.67
$16,666.67
$50,000
$2,777.78
$8,333.33
$33,333.33
$100,000
Please call Jennings County Public Library at 812-346-2091 ext 1225 with any questions about payment
methods or the information requested on this form.
Jennings County Public Library
2375 N State Hwy 3
North Vernon, IN 47265
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