Maryland Uni Division Of Student Affairs Gift Form
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1
28400 Baltimore Ave., Suite 200
College Park, MD 20740
301-314-7918 TEL
301-314-0222 FAX
Division of Student Affairs Gift Form
Men's Rugby Club
1 Donor Information
Mailing Preference:
Home
Business
Name(s):__________________________________________________Organization:_________________________________________
Home Address:_________________________________________________________________________________________________
City:______________________________________________________ State:_________________ Zip Code:__________________
Telephone:___________________________ E-Mail:___________________________________________________________________
Business Address:_______________________________________________________________________________________________
City:______________________________________________________ State:_________________ Zip Code:___________________
Telephone:___________________________ E-Mail:___________________________________________________________________
2 Student Affairs Gift Fund Options
Men's Rugby Club
Amount $_______________
3 Payment Options
Enclosed is my gift check of $_________________ made payable to the University of Maryland College Park Foundation
I would like to charge my contribution of $_________________ to the following credit card:
Master Card
VISA
Discover
American Express
Card Number __________________________________________________ Expiration Date ____________________________
Authorized Signature _____________________________________________________________________________________
I would like to make this gift via payroll deduction (State of Maryland employees only)
My employer will match my charitable contribution to this fund. Enclosed is the completed and signed matching gift form.
Please contact me regarding a gift of stock, real estate, personal property or wire transfer.
4 Multi-Year Pledge
I am pledging $_________________ and will make __________ annual payments as shown below:
st
1
payment of $_________________ enclosed or due by December 31, 20_____
(If enclosed, please also complete section 3)
nd
2
payment of $_________________ due by December 31, 20_____
rd
3
payment of $_________________ due by December 31, 20_____
th
4
payment of $_________________ due by December 31, 20_____
th
5
payment of $_________________ due by December 31, 20_____
Signature ____________________________________________________________________ Date ______________________
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