Yes! I want to support the College of Agriculture and Life Sciences at
NC State University. This is my Gift Intention Form.

My Total Gift Amount Will Be: $___________.

___My gift is __in honor   __memory of: ______________________________

Please notify: Name(s)______________________________________________
Address(es)_______________________________________________________
________________________________________________________________

I wish my gift to support the following area(s):

___Student Scholarships -- general

___Student Scholarships -- (specify major)____________________________________

___Student Fellowships -- general

___Student Fellowships -- (specify major)_____________________________________

___Program/Center Support (specify)________________________________________

___Department Support (specify)___________________________________________

___Unrestricted – Dean’s or Director’s Discretion (specify)
_______________________________________________________

___Specific Endowment or Fund (specify)_____________________________________

___A check for the total amount of $_______ is enclosed.

__Please charge my entire gift amount to: __AmEx  __Discover  __Visa  __MasterCard             

Expiration____________
Card Number______________________________________


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.


__A completed Payroll/Bank Draft Authorization Form is enclosed.

__This is a company pledge.  Company Name__________________________________

___I would like to fulfill my contribution using a gift of appreciated securites. Please
contact me.

__Please send me information on ways of including CALS in my estate plans.

(Print) Name__________________________________________
Employer(many match gifts!)______________________________

Title______________________ 
FAX______________________
Phone____________________(day) ___________________(eve)
Email________________________________________________
Website_____________________________________________

Address_____________________________________________
___________________________________________________

Please print this page. You may make checks payable to The North Carolina Agricultural Foundation
(you will receive an official receipt for your contribution, and pledge reminders if you have chosen that option).
Send to: NC Agricultural Foundation,  NC State Box 7645, Raleigh, NC 27695. (FAX: 919-515-5274) 
If you have any questions or require additional information, please call Chris Cammarene-Wessel
at 919-515-7678 (chris_wessel@ncsu.edu).

 

CALS Payroll/Bank Draft Authorization Form


Please type or print clearly and return with completed Gift Intention Form.


Full Name: __________________________________________________________________

I wish to make the following contribution in support of the College of Agriculture and Life Sciences
as indicated on the completed Pledge Intention Form. My total contribution amount will be: $____________.

 

I understand that the amount designated below will be deducted each month for a period of ____ years (1-5) OR
____ months (5-11).
My monthly deduction will be:
$500____  $450____  $400____  $350____  $300____  $250____  $200____  $150____  $100____ 
$75____  $50____  $25____  $10____ Other $____(must be greater than $10)

Forms must be received by the third business day of the month in which you wish the deduction

to be effective.

Signature: ____________________________________________  Date: __________________

Social Security # (non-NC State employees only): __________________________

HR ID # (NC State Employees only): _______________________________

Home Address and Phone: _______________________________________________________________
_____________________________________________________________________________________

Financial Institution: _____________________________

Account Number: __________________________

For Bank Draft, please attach a voided check or deposit slip with your account number on it.







for office use only :  ID#_________________      Add. Change?_____       Advance Acct.
#__________________

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