PAYROLL DEDUCTION DONATION FORM
To make a gift to Saint Mary's University, please complete this form and mail to the address below.
Saint Mary's University Development Office 867 Robie St Halifax NS B3H 3C3 Tel 902-420-5496 Fax 902-420-5140
A charitable tax receipt for all donations will be issued through your annual T4 form.
(Please enter name(s) as you wish them acknowledged. If you and your spouse are both Saint Mary's University Alumni, please
indicate how you wish your gift to be credited.)
Date: mm____/dd____/yy____
Please print your name and address below:
Title: Dr. Ms. Mrs. Miss. Mr. (circle one)
First Name:___________________________ Middle Name:___________________ Last Name:_________________________________
Home Address: __________________________________________________________________________________________________
City: ______________________________ Prov: __________ Postal Code: ___________ Country: _______________________________
Home Phone: ___________________Work Phone: _______________________Email: _________________________________
My total gift pledged to Saint Mary's University is $ ________________*
***The total pledged amount will be divided by 26 pays per year**
Gift Designation
Area of Greatest Need Athletics
Scholarships/Bursaries )UHG6PLWKHUV Centre of Support for Students with Disabilities
Library Acquisitions Other _______________________________________________
Payment Options
Bi-weekly Payroll Deduction Program. I authorize Bi-weekly payroll deductions of $____________to start
___/___/___.
For _________years
Signature: ________________________________Date: _____________
I wish my donation to remain anonymous.
Please do not publish my name in any donor listing
Planned Giving
I have made provisions for Saint Mary's University in my will.
I would like to receive information about including Saint Mary's University in my will.
Please send me information about Planned Gifts (e.g., life insurance policy, bequest).
Thank You!
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