Lifesavers Match Campaign Form

Please use this form to "pledge" gifts you will be making by check, stock, IRA, advised fund, other.

(To use a card, instead, find the appropriate form at donatelifenw.org/Lifesavers ) Thank you for pledging support through the Lifesavers Match Campaign! Please complete the form below so that it can be counted in advance, as a pledge for the Matching Challenge. To pledge multiple quarterly or annual payments, please note your schedule, and your entire pledge amount will be eligible for the match.

Mailing Address & Stock Transfer Information

Donate Life Northwest
PO Box 532
Portland, OR 97207
IRS ID 93-0867552 (Donate Life Northwest is a a 501(c)3 charity)
Stock Transfers: DTC: 0701 (Cetera / CB Financial) Account: 2AZ17932 (Donate Life Northwest, IRS ID 93-0867552)

Gift Type

this is a ONE-TIME GIFT

I pledge ONGOING SUPPORT

Select whether your gift is a ONE-TIME GIFT or if you would like to pledge ONGOING SUPPORT by giving monthly, quarterly, or annually.

Gift Amount

Please indicate the amount you intend to give. If you selected ONGOING SUPPORT above, please include notes on how much and often you would like to give. For example: "$250 / quarter for 1 year" or "$100 / year for 5 years"

Payment Type*

by Check: I'll mail my check(s) to Donate Life NW, P.O. Box 532, Portland OR, 97207

Other: I'll be giving stock, IRA distribution, advised fund gift, or other (estimated dates and description, above)

Contact 1

First Name

Last Name

Country

Street Address

City

State/Province

Postal Code

Phone Number

This is a joint gift between myself and:

I was invited by:

Name of captain

My company will match my gift:

Please list your company here.

Additional Comments

If you would like to be emailed an invoice or have an additional request, please note it here.

Activity Subject

Activity Details

Stories of Hope

— Norrine Smokey-Smith

Lifesavers Match Campaign Form

Please use this form to "pledge" gifts you will be making by check, stock, IRA, advised fund, other.

Mailing Address & Stock Transfer Information