Faculty and Staff Pledge Form
Webster University 2014-2015
Please return your completed form to
Webster University, 470 E. Lockwood Ave, Loretto Hall #472, St. Louis, MO 63119 or annualfund@webster.edu
Questions may be directed to Julianne Smutz, 314-968-7161 or juliannesmutz72@webster.edu
FS1415
/
Name: CARS ID #
Address:
City, State, Zip:
Phone: Department:
E-Mail: Campus:
Honor Roll Name*
*Gifts of any amount are listed in the honor roll at the Faculty and Staff Recognition Breakfast and the. Please indicate on the line above how you
would like your name to appear or simply mark the field “anonymous” if you do not want your name included in the honor roll.
ONE-TIME GIFT PLEDGE
I wish to make a gift of $ ____________
in support of Webster University!
Please select one of the payment methods below.
Check payable to Webster University enclosed.
I wish to pay via Credit Card:
Visa MasterCard Discover
Card Number
Expiration Date Security Code
(Last 3 digits on back of card)
Give Online. It’s fast, easy and secure.
Visit www.webster.edu/giving
I wish to pledge $ ____________
in support of Webster University!
Please select one of the payment methods below.
I authorize Webster University to deduct $______
per pay period via payroll deduction beginning
on the
next available payroll and continuing for
the term of one year. Please indicate your
anticipated number of pay periods for the next 12
months, based on your employment status:
______ pay periods. See reverse for examples of
pay schedules and/or to select multi-year payroll
pledge option.
Yes, I’ve selected the multi-year pledge.
See below for instructions
Check payable to Webster University enclosed.
This is the first payment on my pledge. Please
send me Pledge Reminders (check one):
Monthly Quarterly Semi-Annually*
__________________________________
*please specify pledge payment terms
***Don’t forget to fill out and sign the reverse side of this form!***
Multi-year Pledge Instructions
Let’s save time and effort and conserve resources. Please automatically renew my annual payroll
deduction pledge for the following two fiscal years (FY 15-16 and FY 16-17). My Instructions are as follows:
I authorize Webster University to deduct $______ per pay period via payroll deduction, beginning on the next
available payroll and continuing until May 31, 2017. Please indicate your anticipated number of pay periods for the
term from the next available payroll through May 31, 2017, based on your employment status: ______ pay periods
