Gift Intention Form
MY TOTAL GIFT AMOUNT WILL BE: $___________.
__ This is a corporate gift. Company Name_______________________________________________________________________________________
__ A check for the total amount of $_______ is enclosed.
__ I would like to charge my entire gift.
Card Type: __American Express __Discover __Mastercard
__Visa
Card Number: _______________________________
Expiration Date: ____________________________
Name on Card: ______________________________
Signature: __________________________________
__ A check for $________ as my first payment is enclosed. A balance of $________ remains on my pledge and will be paid in equal annual installments over the next ___ (1-5) years.
__ I have completed a Bank Draft/Payroll Deduction Form. Each month for the next ___ (1-5) year(s) $_______ ($10 minimum) will be deducted.
__ This gift is designated for: ___the endowment, ___annual award(s) OR $_____/$_____split (endowment/annual).
(Print)
Name____________________________________________________________________________
Phone____________________(Day) ___________________(Eve.)
FAX_____________________ Email__________________________
Website___________________________________________
Address___________________________________________________________________________________________________
Employer (many match gifts to NC State!)
________________________________________________________
Please make checks payable to The North Carolina Agricultural
Foundation.
You will receive an official receipt for your contribution and
reminders if you have made a pledge.
Send to: NC Agricultural Foundation, NCSU Box 7645, Raleigh, NC 27695.
If you have questions or need more information, please call John
Cornwell at (919)515-3248 (Ag_Institute@ncsu.edu).
or Chris Wessel at 919-515-7678 (chris_wessel@ncsu.edu).