Pledge Intention Form
My Total Gift Amount Will Be: $___________.
______ Please designate $_____ of
my gift for the CALS Floyd Relief Fund (100% of these funds will
directly benefit Eastern North Carolina families and communities impacted
by Hurricane Floyd).
______ Please designate $_____ of my gift to support the NCCESF Benevolence Fund (100 % these funds will directly benefit Extension families impacted by Hurricane Floyd).
______ Please designate $_____ of my gift to support the NCDA Farmer Disaster Fund (100% of these funds will directly benefit agriculture and farm families impacted by Hurrican Floyd.)
A check for the total amount of $_______ is enclosed.
I would like to charge my entire gift amount. Card Type: ___Visa ___MC
Name as it appears on card: ________________________________________________
Card Number:_____________________________________ Expiration Date:_________
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 two years.
I am enclosing a completed
Bank Draft Authorization Form. Each month for the next ___ (1-2) year(s)
$_______($10 min.) will be deducted from my checking account.
Phone__________________(Day) ___________________(Eve.) FAX________________ Email_______________________ Website:______________________________________
Address (campus and home)_______________________________________________
Please make checks payable to The North
Carolina Agricultural Foundation (Tax ID # 56-6049304)
(you will receive an official receipt for your contribution,
and pledge reminders if you have chosen that option).
Send to: NC Agricultural Foundation, NCSU Box 7645, Raleigh, NC 27695 or FAX to 919-515-5274.
If you have any questions or require additional information,
please call Sandy Zaslow at 919-515-2781 (email@example.com)
or Chris Cammarene-Wessel at 919-515-7678 (firstname.lastname@example.org).