Community Educational Television
 
                 Pledge Form


    Date:___________________________________

    Donor#:_________________________________

    Phone:__________________________________

    First Name:_____________________________

    Last Name:______________________________

    Address:________________________________

    Apt#:___________________________________

    City:___________________________________

    State:__________________________________

    Zip:____________________________________

    One Time $:_____________________________
      
	                   O R 

    Monthly $:______________________________



       Mailing Address for Donations:
       Community Education Television
       P.O. Box 721800
       Houston, TX 77272-1800