Cleveland County Arts Council Individual Donation Form
Please complete this form, and enclose it with your payment, payable to: Cleveland County Arts Council.
Mail to: Cleveland County Arts Council
111 S. Washington St.
Shelby, NC 28150.
Name (as you wish listed): ______________________________________________________________
Address: _____________________________________________________________________________
City, State, ZIP Code: _________________________________________________________________
Phone number: _______________________________________________________________________
E-mail address: ________________________________________________________________________
I would like to support Arts Council as a/an:
_ Benefactor ($5,000+)
_ Art Connoisseur ($2,000+)
_ Art Patron ($1,000+)
_ Art Collector ($500+)
_ Art Enthusiast ($250+)
_ Art Curator ($150 +249)
_ Art Lover ($75+)
_ Art Advocate ($50+)
_ Art Friend (less than $50)
Amount enclosed: $_______________________________________________________
I'm making a gift by: _ Cash _ Check _ Visa _ MasterCard _ Monthly Bank Draft (see below)
Bill me: _ Quarterly _ Once in the month of __________________
Card #: __________________________________________________________________
Expiration Date: _________________________________________________________
Signature: ______________________________________________________________
Bank Draft Authorization
For the period dating ________- ________, I authorize the Cleveland County Arts Council to debit my bank account on the 15th of each month to collect my pledged amount to the Arts Fund Drive.
Total Pledge Amount $________________________ Amount per month $ ______________
*Please attach a voided check
Memorials and Honorariums
Cleveland County Arts Council welcomes contributions in honor of those living and/or in memory of those departed. Memorials and honorariums are a fitting way of showing love and respect and/or recognizing individuals for their community service or their good life in general.
If your donation is being made in memory or in honor of someone special please complete the following:
In Memory of: ________________________________________________________
In Honor of: __________________________________________________________
Please send an acknowledgement card to:
Name: _________________________________________________________________
Address: _______________________________________________________________
City, State, ZIP Code: _____________________________________________________
The Cleveland County Arts Council is a 501(c)(3) nonprofit organization under the regulations of the Internal Revenue Service.
All contributions to the Arts Council are tax-deductible to the extent provided by law.
Thank you!
