THE GORDON A. RICH MEMORIAL FOUNDATION
PLEDGE AND PAYMENT FORM

Yes! I wish to make a pledge to The Gordon A. Rich Memorial Foundation

TOTAL PLEDGE AMOUNT:   TO BE PAID OVER:   YEARS (UP TO 5 YEARS)
NAME  
ADDRESS  
CITY   STATE   ZIPCODE  
TELEPHONE  
EMAIL ADDRESS  

 

In addition, a matching gift will be made by:

NAME OF COMPANY  

Please indicate Matching Gift Form

 

Checks should be made payable to:
The Gordon A. Rich Memorial Foundation
c/o: Joyce Gross
170 Gerhard Road
Plainview, NY 11803
516-428-6350

PAYMENT AMOUNT ENCLOSED:  

 

SECURITIES
If you plan to give securities, you may notify The Gordon A. Rich Memorial Foundation of the specifics of the gift, and have your banker or broker request transfer instruction from: