Yes! I want to support the College of
Agriculture and Life Sciences at
NC State University. This is my Gift Intention Form.
Amount Will Be:
___My gift is __in honor __memory of: ______________________________
I wish my gift to support the following area(s):
___Student Scholarships -- general
___Student Scholarships -- (specify major)____________________________________
___Student Fellowships -- general
___Student Fellowships -- (specify major)_____________________________________
___Department Support (specify)___________________________________________
– Dean’s or Director’s Discretion
Endowment or Fund (specify)_____________________________________
___A check for the total amount of $_______ is enclosed.
__Please charge my entire gift
amount to: __AmEx
Expiration____________ Card Number______________________________________
Name on card__________________________________________________________
__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
__Please send me information on ways of including CALS in my estate plans.
Employer(many match gifts!)______________________________
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 (firstname.lastname@example.org).
CALS Payroll/Bank Draft Authorization
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
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
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.