Fillable Gift/pledge Form printable pdf download

Gift/Pledge Form

DONOR INFORMATION

Name: _________________________________ _____________________________

___________________________________

First

Middle

Last

Alumnus

Graduation Year __________

Parent

Friend

Joint gift with spouse ___________________________ ________________________

______________________________

First

Middle

Last

Alumnus

Graduation Year __________

Parent

Friend

Address: ___________________________________________________________________________________________________

__________________________________________________ ______________________

_______________________

City

State

Zip

Email Address: ________________________________________ Home Phone: ___________ _____________________________

Area Code

Cell Phone: __________ _______________________________ Business Phone: __________ _____________________________

Area Code

Business Name: _____________________________________________ Title: ___________________________________________

Business Address: ____________________________________________________________________________________________

GIFT INFORMATION

I/We wish to support the university with a gift of $ _________________

Enclosed is my check made payable to UT Foundation

Please charge my gift to my credit card.

VISA

MASTERCARD

DISCOVER

AMEX

Name as it appears on card ____________________________________________________________________________________

Card Number: _________________________________________ Expiration Date: _________/_________ CVV: ________________

Signature: __________________________________________________________________________________________________

PLEDGE OPTION

I/We wish to make a total pledge of $_________________ fulfilled via equal

monthly

quarterly

semi-annual

annual

installments of $_________________ beginning ___________________________.

Date

DESIGNATION

I/We would like to designate my/our gift/pledge to (Campus, College, Department, Library, or Specific Program):

_______________________________________________________________________________________________________

In memory of ___________________________________

In honor of _______________________________________

MATCHING GIFTS

Many employers offer as a benefit to their employees a matching gift program. These programs often double, and in some cases triple, the effective value of

your contribution. If you would like to participate in this program or if you need additional information on your company’s program or policies, contact your

employer’s Human Resources or Employee Benefits office for specific details.

I/We work for a Matching Gift Company. My employer is ___________________________________________________________

Enclosed is a completed matching gift form. Please verify and file with my employer.

I have applied online for a matching gift; you should receive notice from my employer.

Visit for matching gift information.

Return completed form by mail to: The University of Tennessee Foundation Inc.

University of Tennessee Health Science Center • 62. S. Dunlap, Suite 520 • Memphis, TN

38163 Phone: (901) 448-5516 • Fax: (901) 448-5906