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)_____________________________________
___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.