I/We wish to honor and remember Dr. Eloise S. Cofer.

Gift Intention Form

My/Our Total Gift Amount Will Be: $___________, as indicated below.

$______ to Eloise Cofer Endowment: Arts NC State
$______ to Eloise Cofer Endowment: JC Raulston Arboretum
$______ to Eloise Cofer Endowment: NCCES Foundation
$______ to Eloise Cofer Endowment: NC State Libraries
$______ to Eloise Cofer 4-H Scholarship Endowment
$______ to Eloise Cofer Family & Community Issues Forum End.

__ This is a corporate gift.  Company name_______________________________________________________________________________

__ A check for the total amount of $_______ is enclosed.

__ I would like to charge my entire gift amount.  Card Type: __American Express  __Discover  __Mastercard  __Visa
Name on Card:_____________________________Expiration Date:________
Card Number:________________________Signature__________________________

__ (For gifts of $150 or more) 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.

__ (for gifts of $120 or more) I am enclosing a completed Payroll Deduction/Bank Draft Authorization Form.  Each month for the next ___ (1-5) year(s) $_______($10 min.) will be deducted.

__ I am interested in learning about ways of supporting the College of Agriculture and Life Sciences.  Please call me.

(Please print or type.) Name________________________________________________________________
Phone_________________(Day) _________________(Eve.) FAX________________ Email_________________________ Website:________________________________
Addresses (office/home)_________________________________________________
Employer (many match gifts!)______________________________________________

Please make checks payable to the endowment(s) selected.
(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 University Box 7645, Raleigh, NC 27695.
Or, you may fax your forms to 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).

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 Last modified:  October 2004