Xenos Pledge Program

Is this a revised pledge, which will replace your previous pledge?

No
Yes

Note that if this is a revised pledge, you may simply explain the increase or decrease in the Comments below without having to fill in the total amounts.

Having considered this before God, I/we make the following commitment(s):

My/our pledge for	toward the
to be given
consisting of	(number of remaining payments)
equal payments of $	(calculate total)
for a grand total of $	(calculate payments)

I would like to EFT (electronic funds transfer) my pledge.
I will turn in my completed EFT authorization form.

Yes
No

If this is a General Fund pledge, I affirm that it qualifies for membership on the Xenos Fiscal Support Team. I/we would like to join the Fiscal Support Team for the pledge year above.
Note that FST qualification applies to pledges for the General Fund only.

Yes
No

Name:
Address:
City:	State:	Zip:
Phone:	Email:
Comments:

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Information in red is required

If you have any questions, you may e-mail Alan Burkholder or reach him at 823-6510 x146.