Gift/Pledge Form

You can give quickly and securely at Otherwise, please return this completed form to the Pennsylvania Kiwanis Foundation. If you have any questions, please contact us at or at 717.540.9300. / Pennsylvania Kiwanis Foundation
2793 Old Post Road, Suite 12
Harrisburg, PA 17110
717.540.9300 Fax: 717-540-1018

Donor Information

Donor to be Credited - First and Last Name / Kiwanis Family Member Number
(if applicable)
Address
City / State / Zip Code
Home Phone Number / Cell Phone Number
E-mail
Kiwanis Family Club Name and Location (if applicable)
Preparer’s First and Last Name / Preparer’s Phone Number

Gift/Pledge Information

PART A:I would like this gift:
(Please put only one “X” in the box to the right.)
Unrestricted – Allows the Foundation to put the gift to the best use.
Restricted – Gift will be used for a specific fund through the Foundation. Please see table to the right.

PART B:
Gift/Pledge in US$ ** / $
If a pledge, please enclose initial pledge and indicate payment amount.
Payment Amount in US$ / $

PART C:Please indicate any below with an “X” in the box to the right if any below apply.
This gift is anonymous.
This gift is a surprise.
My company will match this gift.
Please indicate below if you have any special instructions or notes.
/ If gift is restricted, please indicate the fund for the gift. (Please put only one “X” in the box to the right.)
Early Childhood Learning
Scholarships
Other:
Pledge Installments:
Installment Payment US$ / $
Pledge Installment Time (Monthly, Quarterly, Semiannually, Annually)
Beginning (Month/Year)
Ending (Month/Year)
** Note: Gifts over $100 qualify for a donor’s recognition award as follows. Donor recognition awards are usually presented at the Annual Kiwanis District Convention. Pledges are not recognized as gifts until complete payment is made.More information on each recognition is available on
  • Century Award - $100
  • Patron Award - $500
  • Pliny J. Wilson Award - $1,000
  • Tablet of Honor Award - $2,000
  • Keystone Award - $5,000

Gift Payment

I wish to make my payment by:
Check
Credit Card
/ If payment by credit card, please complete the following information:
Card Type
(Visa, MC, Discover, Amex)
Card Number
Card Expiration Date
CV2 Code
Name as it Appears on Card
Signature
Date

The Pennsylvania Kiwanis Foundation is a non-profit organization under Section 501(c)(3) of the Internal Revenue Code, EIN 23-2149735. It is understood that contributions may be tax deductible. No goods or services are given in return for donations. The official registration and financial information of Pennsylvania Kiwanis Foundation may be obtained from the Pennsylvania Department of State by calling 800-732-0999 toll free in Pennsylvania. Registration does not imply endorsement.