Annual Fund Form

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2014-2015 Annual Fund Form
(for Cash, Checks, Payroll Deductions, & Credit Card Gifts)
Gift Levels:
My contribution is to be used for:
1896 Society ……………………………………$119
Annual Fund/Unrestricted: $ _______________
Bulldog Society ……………………..$249 and below
Athletics: $_____________
Palmetto Society…………………………$250 - $999
Marching 101 Band Fund: $__________________
Garnet and Blue Society ……………..$1,000 - $2,499
Class Reunion: $____________ Class of ___________
Presidents’ Society……………………$2,500 - $4,999
Scholarship Gala & Tribute: $___________________
Founders’ Society…………………...$5,000 and above
Alumni Heritage Endowment Fund: $_____________
WSSB Radio Station: $_____________
- (please check one):
Method of Payment
Please make check payable to SCSU Foundation.)
I have enclosed my gift of $______________
(
For SC State University employees only.)
Payroll Deduction: (
Gift Amount $__________ Please deduct $__________ from my pay, at $________ per pay period.
Starting on __________________________ Ending on_________________________________
I wish to charge the gift amount of $______ to my credit card:
VISA
MasterCard
Discover
American Express
Credit Card #: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Expiration Date: ____________
Signature: __________________________________________________ Date: ____________________
(For SC State University employees only.)
Banner #: ______________________________
Your signature is required to process your payroll deduction and credit card contribution.
Name: ______________________________________________________
Class Year ____________
Address: _____________________________________________________________________________________________
City, State Zip: ____________________________________________________________________________________
Home Phone: __________________________________ Mobile Phone: _______________________________________
E-Mail: _______________________________________________________
~~All gifts given to support the above initiatives are counted as part of the South Carolina State University Annual Fund which begins
July 1, 2014 and ends June 30, 2015. All gifts to South Carolina State University through the SCSU Foundation are tax deductible
within the limits of the Internal Revenue Code. For additional information, please contact the Division of Institutional Advancement
at 803-536-8742 or 803.536.7190.
Please return this form to:
SCSU Annual Fund Drive
Post Office Box 7305
300 College Street Northeast
Orangeburg, SC 29117-0001
Fax: (803) 536-8429
Thank you for your Support!

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