Gift Pledge Form

Payments for 2013 and past pledges may be made securely on this form. Your support strengthens Catholic Charities and the many other services and missions of the Catholic Church in Fairfield County.

Required fields are indicated with bold labels.

First Name
Last Name
Donor ID*	*Located next to your parish name on your pledge card (if received)
Address
Address2
City/Municipality
State	None Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Province	Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
Zip/Postal Code	-
Parish	----- Select Your Parish ----- Not Registered With a Parish Assumption, Westport Blessed Sacrament, Bridgeport Christ the King, Trumbull Holy Cross - Fairfield, Fairfield Holy Family, Fairfield Holy Name of Jesus, Stamford Holy Name of Jesus, Stratford Holy Rosary, Bridgeport Holy Spirit, Stamford Holy Trinity, Sherman Immaculate Heart of Mary, Danbury Notre Dame, Easton Our Lady - Star of the Sea, Stamford Our Lady of Assumption, Fairfield Our Lady of Fatima, Bridgeport Our Lady of Fatima, Wilton Our Lady of Good Counsel, Bridgeport Our Lady of Grace, Stratford Our Lady of Guadalupe, Danbury Our Lady of Peace, Lordship Sacred Heart, Danbury Sacred Heart, Georgetown Sacred Heart, Greenwich Sacred Heart, Stamford St. Agnes, Greenwich St. Aloysius, New Canaan St. Ambrose, Bridgeport St. Andrew, Bridgeport St. Ann, Bridgeport St. Anthony, Fairfield St. Augustine Cath, Bridgeport St. Benedict - Montserrat, Stamford St. Bridget, Stamford St. Catherine, Riverside St. Catherine, Trumbull St. Cecilia, Stamford St. Charles Borromeo, Bridgeport St. Clement, Stamford Sts. Cyril/Methodius, Bridgeport St. Edward the Confessor, New Fairfield St. Elizabeth Seton, Ridgefield St. Emery, Fairfield St. Francis of Assisi, Weston St. Gabriel, Stamford St. George, Bridgeport St. Gregory, Danbury St. James, Stratford St. Jerome, Norwalk St. John, Darien St. John the Evangelist, Stamford St. Joseph, Brookfield St. Joseph, Danbury St. Joseph, Shelton St. Joseph, S. Norwalk St. Jude, Monroe St. Ladislaus, S. Norwalk St. Lawrence, Shelton St. Leo, Stamford St. Luke, Westport St. Margaret Mary, Shelton St. Margaret Shrine, Bridgeport St. Marguerite, Brookfield St. Mark, Stratford St. Mary, Bethel St. Mary, Bridgeport St. Mary, Greenwich St. Mary, Norwalk St. Mary, Ridgefield St. Mary, Stamford St. Matthew, Norwalk St. Maurice, Stamford St. Michael, Bridgeport St. Michael the Archangel, Greenwich St. Patrick, Bridgeport St. Patrick, Redding Ridge St. Paul, Greenwich St. Peter, Bridgeport St. Peter, Danbury St. Pius X, Fairfield St. Philip, Norwalk St. Raphael, Bridgeport St. Roch, Greenwich St. Rose of Lima, Newtown St. Stephen, Trumbull St. Theresa, Trumbull St. Thomas, E. Norwalk St. Thomas Aquinas, Fairfield St. Thomas More, Darien
E-Mail

You must provide an email address to make your pledge or payment online. If you do not have an e-mail address please contact our office by phone at 203-416-1472. I do NOT want to receive email updates from the Diocese

Home Phone	- -
Cell Phone	- -
Employer/Company
Job Title

Spouse Information

Spouse Name
Spouse E-mail
Cell Phone	- -
Employer/Company
Job Title

Pledge Information

Pledge Amount $

Direct My Gift To

Unrestricted Catholic Charities Inner-city Catholic Elementary Schools Seminarians Retired Priests Hospital and Nursing Home Ministries Catholic Schools

Please add $10 to my pledge to defray postage costs for Fairfield County Catholic.

Select One		Please charge the full amount of my pledge to a Credit Card today.
		Please charge a Credit Card in five equal installments for my pledge.
		I would prefer to be reminded and will pay off my pledge balance before the end of the year.
		This is a payment on my pledge for 2013 or a past pledge.

Card Type	American Express Discover Mastercard Visa
Credit Card #	- - -
Security Code
Cardholder
Exp. Date	01 02 03 04 05 06 07 08 09 10 11 12 / 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Mail Checks to:	Annual Bishop's Appeal Diocese of Bridgeport 238 Jewett Avenue Bridgeport, CT 06606

Do you or someone you know need prayer? Please list your prayer requests on the form below. We pray for all your requests during daily Mass.
Prayer Request

Anything else you need to share with us? Please use the box below.
Comments or Notes to Staff

Are you interested in volunteering?       Yes        No
	If yes, please enter your phone number: Your e-mail address: A member of our staff will contact you!