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KAZI DONATION PLEDGE FORM

Mail your pledge to:

KAZI 88.7 FM
8906 Wall St. #203
Austin, Texas 78754

Name: ________________________ Organization: ___________________________________

Address: ____________________________________________________________________

City: ________________________ State: ____________ Postal/Zip Code: _______________

Day Phone: _____________________ Evening Phone: ____________________________

Pledge Amount:

$________________

MAY WE THANK YOU ON THE AIR? __ YES __ NO

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Payment Method: Check____ Cash Drop-Off____

(If Check) Driver’s License #: ________________________________________State: _____

Donation Check will be Mailed or Deliver by: ______________/____________/_____________

--------------------------------For Official Use Only------------------------------------

Date Received: _____/_____/_____ Amount Collected: $______________ Receipt # ________

Call Backs: ___________ ___________ __________ __________ _________

THANKS FOR YOUR SUPPORT!