Gift Intention Form
MY TOTAL GIFT AMOUNT WILL BE: $___________.
__ This is a corporate gift. Company name_____________________________________________________________________________________
__ A check for the total amount of $_______ is enclosed.
__ I would like to charge my entire gift.
Card Type: __American Express __Discover __Mastercard __Visa
Card Number: _______________________________
Expiration Date: ____________________________
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.
__ I have completed a Bank Draft/Payroll Deduction Form. Each month for the next ___ (1-5) year(s) $_______ ($10 minimum) will be deducted.
FAX_____________________ Email__________________________ Website___________________________________________
Employer (many match gifts to NC State!) ________________________________________________________
Please make checks payable to The North Carolina Agricultural
You will receive an official receipt for your contribution and reminders if you have made a pledge.
Send to: NC Agricultural Foundation, NCSU Box 7645, Raleigh, NC 27695.
If you have questions or need more information, please call Hosni Hassan at 919-515-2391 (email@example.com)
or Chris Wessel at 919-515-7678 (firstname.lastname@example.org).