Big Brothers Big Sisters of Greater Rochester
Please print and use this form for your donation.

Once completed, mail this form and gift to:

Executive Director
Big Brothers Big Sisters of Greater Rochester
232 South Plymouth Ave.
Rochester, New York 14608

I would like to pay by:
___ Check Enclosed (Please make payable to Big Brothers Big Sisters. )
___ VISA or ___ Master Card in the amount of $________.____
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| exp. ___/___
All contributions are tax-deductible as allowed by law.
Your Name: ___________________________________________________
Address: _____________________________________________________
City: ____________________________ State __________ Zip __________
Phone (_____) ______ - __________ (We only need to call if we have payment questions)
E-mail Address: _____________________________________________
(To be held in privacy)
My gift is made in recognition of*: This is the first donation in a pledge of
  • ___ All County
  • ___ Genesee County
  • ___ Livingston County
  • ___ Monroe County
  • ___ Ontario County
  • ___ Orleans County
  • ___ Wayne County
  • ___ Wyoming County
  • ___ Yates County
  • ___ 2 Years
  • ___ 3 Years
  • ___ 4 Years
  • ___ 5 Years

"Magic Circle" Pledges are $1,000 or more pledged for 5 years.

  • ____ Check here if you are a "Big Benny" donor (over $225 dollars for multiple years)
  • ____ Check here if you are a "COUL Balance" donor (an active COUL Volunteer)
  • ____ Check here if you would like assistance setting up online payments.
Is there anything else you would like us to know about your donation?
 
 
* Overall levels of recognition affect the maintenance and growth of an area of operation. However, recognition of an area of operation does not legally restrict funds in any way. Big Brothers Big Sisters of Greater Rochester, Community Partners for Youth, Inc. retains the discretion to distribute funds in the best interest of all children in our service area.