* indicates required field

Last Name*:                   First Name*:

Spouse's Last Name:         Spouse's First Name:

Statements will be mailed to me quarterly at:

Street Address:    City:    State:  Zip:

Evening phone:     daytime phone:   

Email (required for web pledging so we can mail you back a confirmation)*:

My pledge for 2007 was (optional):  $

I am a weekly/monthly contributor and would like payment envelopes

If paying by credit card, please check one or the other:
Please use my same credit card as last year.  Optional: My new card expiration is

Or, I will call Judy Bellack (Parish Bookkeeper) with my MasterCard/Visa account number.  (650) 591-0328 x103

If you want to send a short note to Judy with your pledge, please type it here:
(e.g. "Please call me on the afternoon of the 10th to discuss this pledge.")

At the same time your pledge info is sent to Judy a second email with only your name
and your email address will be sent to Cliff West, our Parish Administer, to keep a count of pledges.

You can also email Judy directly at judy@churchoftheepiphany.org if you have questions or suggestions.