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:________
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/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.)
Name________________________________________________________________
Phone_________________(Day) _________________(Eve.) FAX________________
Email_________________________ Website:________________________________
Addresses
(office/home)_________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Employer (many match
gifts!)______________________________________________
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, 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).