Donation
Amount and
Directed
Use: |
____ $50
____ $100
____ $200
____ $300
|
____ $400
____ $500
____ $1,000
____ Other amount: $______ |
____Use my gift where the need is greatest.
____Direct my gift to be used in __________________________________ |
 |
Donor
Information: |
First Name |
|
| Last Name |
|
| Street address |
|
| City |
|
| State, Zip Code |
|
| Daytime phone |
|
| Email |
|
| ____ I prefer to make this gift anonymously. |
|
Payment
Method: |
____My check is enclosed |
| ____Please charge my credit card: |
Credit Card Type: __VISA __MasterCard __ American Express
Credit Card Number: _________________________
Expiration Date (month/year): ________________ |
| You may also make a secure online credit card donation. |
|
Recurring
Donations: |
____ Please charge my credit card monthly until ________________ (month/year) |
| ____ Please send me reminders:
____ by email ____by mail |
|
Gift
Information: |
I'd like to make this gift in memory of, or to honor: |
| Name |
| Reason for Tribute |
Please send acknowledgment of this gift to:
__________________________________________________________
|
| ____ Do not include the amount of the gift in this acknowledgment. |
|
|
|
Matching
Gifts: |
_____ My company will match this contribution.
(Please ask your Human Resources or Finance Office for a matching gifts form to enclose with this form.) |
