The form below that you complete online is available here to download and print for your records.
The downloadable version of the forms requires the free Adobe Acrobat PDF Reader to open. Title 26, United States Code Section: 2501,2502,2503,2504,2511
I, the undersigned do hereby declare under penalties of perjury that the following statements are true and correct to the very best of my knowledge Any and all property of any nature that I transfer from my ownership and possession to the pennies in a pond gift activity is intended as a gift and not as an investment. I have not been sold anything and I have not purchased anything, and I have not been offered any opportunity to do so. I have been told to not expect any return of any nature, With this statement I waive any and all my rights to civil or criminal remedies against pennies in a Pond of my gift and the gift activity as a whole, in consideration of the property that I have been transferred as a gift. I am totally within the law, as it pertains to my activities herein described. My intent is to give a gift of the undersigned amount to "Pennies In A Pond as an individual, I acknowledge and Authorize pennies in a pond gift activity to debit/charge my account on file for my charitable gift. I agree upon click i agree gift statement my account will be debited, for the amount as a recurring donations for a period of (1) to(3)or(6) months and will automatically terminate as agreed. My gift does not entitle me to any future opportunity or benefit of any nature. I understand that the gifting activity accepts only gifts donations. All gifts are welcome I have agreed under this gift contract to not reassert any rights to the property that I now give freely as a gift to pennies in a pond gift activity to be used as they see fit for the services they provide to empower and transform a me and you world, versus a you or me world. I am a fully informed and consenting adult and I have not been misled in anyway. I do hereby declare under penalties of perjury that the foregoing statement is true and correct, and are binding upon me to the full extent expressed therein. It is agreed that an electronic acknowledgement submitted by clicking "I Agree" below or a fax copy of this document will be considered legal and enforceable as an original.