Online Heritage Society Pledge Form

Dalmatian Club of America Foundation, Inc

Full Name(Required)

Address(Required)

City(Required)

State / Zip Code(Required)

Fax

Telephone(Required)

E-mail(Required)

Attorney or Executor

Address

City

State / Zip Code

Fax

Telephone

E-mail

Approximate amount of bequest (Minimum $2,500)

Other form of planned gift:

Insurance

Trust Fund

Retirement Beneficiary

Other

Please specify(Required)

Approximate amount of other form of planned gift (Minimum $2,500)

I have made plans to benefit the Dalmatian Club of America Foundation (DCAF) in my will /estate and give my permission to list my name as a member of the Heritage Society on their donor list in THE SPOTTER.(Required)

I have made plans to benefit the Dalmatian Club of America Foundation (DCAF) in my will /estate and give my permission to list my name as a member of the Heritage Society on their donor list in THE SPOTTER.

I prefer to remain anonymous and keep this pledge confidential.

Signature(Required)

Signature

Date

MM slash DD slash YYYY

Please refer any questions and/or return this completed form to: Carol O’Brien, Chair, Heritage Society, 3904 Chippenham Road, Durham, NC 27707 cob@carolobrienassociates.com

A non-profit charitable Corporation

For the Health of Dalmatians and all canines…

The Dalmatian Club of America Foundation (DCAF) is a non-profit charitable Corporation devoted to advancing the health and quality of life for Dalmatians and all dogs through supported research, rescue and education.

We welcome your support

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The Foundation has received from the IRS 501 (c) (3) nonprofit status and is registered under EIN 61-1280243.

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Copyright Dalmatian Club of America Foundation.