St. Agnes Academy - St. Dominic School On-Line Donations

St. Agnes Academy - St. Dominic School
On-Line Donations

Donate with confidence. You're on a Secure Server!

Donor Information

= required

Full Name *

Affiliation *

Year of Graduation

(4 digits, if applicable)

Address Line 1 *

Address Line 2

City *

State/Province *

Postal/Zip Code *

Country

Daytime Telephone *

Email *

Recognition

Please indicate how you would like your name(s) to be recognized in our Donor Listings.

I wish for my name to remain anonymous

Credit Card Information

I would like to contribute:

Total Donation Amount (US$) *

Please debit my credit card *

Annually
Quarterly
Monthly	with payment/installments of (Amount US$)
One-time Gift

Please keep my credit card details on file for any installment payments

Credit Card Type *

Credit Card Number *

Expiration Date *

Name on Card *

Directed Donations

* I would like this gift to be directed to:

$ Annual Fund
$ Kelly Schaffler Annual Scholarship
$ Mandy Smith Annual Scholarship
$ Michelle Sting Annual Scholarship
$ Anita Tadin Annual Scholarship

$ Endowment
$ Kristin Hargett Endowed Scholarship
$ Angela Andreuccetti Endowed Scholarship
$ Rose Ferrante St. Dominic Endowed Scholarship
$ Margaret McNulty Walsh Endowed Music Scholarship
$ Other (Please Specify)

Matching Gifts?

Please indicate whether your employer or your spouse's employer will match your gift.

	Yours \|	Spouse	Organization Name(s)
Yes, matching form will be sent later
No, matching not available

Please fax your form to Jane Tonning at 901-435-5866 or mail to Jane Tonning, St. Agnes Academy-St. Dominic School, 4830 Walnut Grove Rd, Memphis, TN 38117.

In Honor/Memory of

I would like this gift to be in Honor/Memory of:

Name(s)

In Honor In Memory

Please send an acknowledgment of my gift to:

Name

Address

Special Instructions

Any special instructions we should know?

Thank You! Your receipt will be mailed to the above address.