PLEDGE FORM

I/We hereby pledge $ ________ (__________________ Dollars) to Riverdale Neighborhood House, to be paid as follows:

a) Lump sum

b) Annual installments to be paid over ____ years as follows:

Please list my name as follows (for recognition purposes)

_____________________________________________________________________________________________

First Signature: ______________________________ Date: ______________

Name (Printed):_____________________________________________________

Second Signature: ____________________________Date: _____________

Name (Printed):_____________________________________________________

Address:___________________________________________________________

On behalf of the Board, the Staff and the participants of Riverdale Neighborhood House, please accept our heartfelt thanks.

Please return this form to: Mr. Daniel Eudene, Executive Director

Riverdale Neighborhood House

5521 Mosholu Avenue

Bronx, New York 10471