As a colleague of Dr. Carm Parkhurst, I want to help establish the
Carmen R. "Carm" Parkhurst Poultry Science Teaching Program Endowment.


Printable Gift Intention Form for NC State Faculty, Agents, Specialists and Staff

My Total Gift Amount Will Be: $___________.

__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_____________________________

__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 Form. Each month for the next ___ (1-5) year(s) $_______($10 min.) will be deducted from my paycheck.

__I am interested in learning more about establishing named endowments. Please call me during the:
                                                                    __day     __evening.


(Print) Name__________________________________________________________________

Phone___________________(Day) ___________________(Eve.) FAX____________________

Email____________________________ Website:_____________________________________

Address (campus/home)__________________________________________________________

____________________________________________________________________________

____________________________________________________________________________


Please 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, NCSU 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 Gerald Havenstein at 919-515-5555 (gerald_havenstein@ncsu.edu) or Chris Cammarene-Wessel at 919-515-7678 (chris_wessel@ncsu.edu).