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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 ) 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
Select whether your gift is a ONE-TIME GIFT or if you would like to pledge ONGOING SUPPORT by giving monthly, quarterly, or annually.
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
Contact 1
Name of captain
Please list your company here.
If you would like to be emailed an invoice or have an additional request, please note it here.