The Gordon A. Rich Memorial Foundation

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 1220 Park Avenue
Apt 16D
New York, NY 10128
ATTN: Caroline O'Keefe

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:

The Gordon A. Rich Memorial Foundation
info@GordonRich.org