Fillable Oct17 Foundation Pledge Form (Tennessee Technological University)

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Oct17 Foundation Pledge Form (Tennessee Technological University)

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The Oct17 Foundation Pledge Form (Tennessee Technological University) form is 2 pages long and contains:

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  • 30 check-boxes
  • 29 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Tennessee Technological University

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TTU is an AA/EEO employer. 090-1082-12/Revised 10/17
TENNESSEE TECH UNIVERSITY FOUNDATION
PLEDGE/SUPPORT
Box 5111, Cookeville, TN 38505-0001
alumrecords@tntech.edu
Phone: (931) 372-6102 Fax: (931) 372-6387
Toll Free: (866) 511-6553
Donor Informaon:
Yes! This is a personal or company commitment.
Donor Name(s):_________________________________________________________________________________________
Company Contact Name (if company commitment):____________________________________________________________
Address:_______________________________________________________________________________________________
City:___________________________________________________________ State:___________ Zip:____________________
Preferred Phone:____________________________ Preferred E-mail:______________________________________________
Commitment Informaon: (Pledge cannot be paid with Donor Advised Funds)
Total amount of Pledge: $________________________________ (Do not include matching funds in this total.)
Total to be paid over (#) _____________ years. Will pay $___________________________ per year.
Designaon(s):__________________________________________________________________________________________
First payment to be made (month/year):______________________ or enclosed (Make checks payable to the TTU Foundaon.)
I would like to make payments: Monthly Quarterly Semi-Annually Annually
Please send pledge reminders (month):____________________________________
I will be funding this commitment by Cash/Check Stock/Securies
Credit/Debit Card* Electronic Funds Transfer*
TTU Payroll Deducon†
*Please complete second page for addional payment informaon.
†Requires compleon of the “Authorizaon for Payroll Deducon” form.
My company will match my gi: Yes No
Name of Matching Gi Company:___________________________________________________________________________
Any addional informaon can be added on the second page.
TN
January
TTU is an AA/EEO employer. 090-1082-12/Revised 10/17
Payment Informaon for Credit Card or Electronic Funds Transfer:
Opon 1: Credit Card
Visa MasterCard AMEX Discover
Card Number:_______________________________________
Expiraon Date (MM/YY):_____________________________
Name on Card:______________________________________
Please charge $_________________________ to my account
Monthly Quarterly Semi-Annually
Annually One-Time
Beginning (month/year):______________________________
Ending (month/year):_________________________________
Opon 2: Electronic Funds Transfer
Please include a voided check.
Please deduct $_______________________ from my account
Monthly Quarterly Semi-Annually
Annually One-Time
Beginning (month/year):______________________________
Ending (month/year):_________________________________
I (We) hereby authorize the Tennessee Technological University Foundaon to iniate debit/charge entries as stated above.
The automac recurring debit/charges will be done on the 20th of each month. This authorizaon form is to remain in full
force and eect unl the ending date indicated or unl the Tennessee Technological University Foundaon has received
wrien nocaon from donor(s) (e-mail will suce) of its terminaon in such me and manner as to allow the Tennessee
Technological University Foundaon reasonable opportunity to act upon the request.
______________________________________________________________________________________________________
Donor Signature Date
______________________________________________________________________________________________________
Development Ocer Signature Date
______________________________________________________________________________________________________
Execuve Director Signature Date
______________________________________________________________________________________________________
Vice President for UA Signature Date
Addional Informaon/Notes for Donor or Commitment Informaon:
Internal Use Only:
ID Number(s):_______________________________________________
Account Name:______________________________________________
LOA Required: Yes No
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Oct17 Foundation Pledge Form (Tennessee Technological University)

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Completed 18 July 2020

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