Gift Intention Form
My/Our 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 amount. Card Type:
__American Express __Discover __Mastercard __Visa
Name on Card:_____________________________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 ___ (1-5) years.
__ 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 Department of Family and Consumer Sciences and NC Cooperative Extension Service. Please call me.
(Please print or type.)
Phone_________________(Day) _________________(Eve.) FAX________________ Email_________________________ Website:________________________________
Employer (many match gifts!)______________________________________________
Please make checks payable to The North Carolina Agricultural
(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 (firstname.lastname@example.org).