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2. Donor Information
4. First Name*
5. Last Name*
7. Company
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Cell Phone*
18. Email*
20. Donation Information
22. I would like to donate a total amount of*
23. To be paid:*

    1. at one time
    2. quarterly
    3. annually
25. Payment must be made by March 31, 2026 (Q1) for Phase Two. Donations in excess of $100,000 may be accompanied by a donation agreement.

    Please make checks, corporate matches, and other donations payable to the Village of Kenilworth. 

    The Village wishes to acknowledge your gift, which directly positively impacts the financing of the Beach Improvement Project. Pledges to the Village are tax deductible to the extent allowed by law.  Please recognize, however, that all determinations regarding the tax consequences of this conveyance are within the sole discretion of the Internal Revenue Service (“IRS”) and must be resolved solely between yourself and the IRS.  Nonetheless, if there are any tax-related forms which need to be signed to further acknowledge the Village’s receipt of your pledge, please feel free to contact Village Staff using the contact information provided below. 

    To view the Village Donation Policy please visit: https://www.vok.org/DocumentCenter/View/6623/Beach-Improvement-Project-Donation-Policy?bidId=

    Thank you for your pledge in support on this important once-in-a-generation project. 

27. Electronic Signature*
28. Date*
30. Is your donation to remain anonymous? *

    1. Yes.
    2. No, I would like to be included on the list of donors to recognized at a later date.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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