Fillable Tennessee Tech University Authorization Form for Recurring Gifts

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Tennessee Tech University Authorization Form for Recurring Gifts

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Country of origin: US
File type: PDF

U.S.A. forms for Tennessee Technological University

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UniversityAdvancementRevised10/17
Tennessee Technological University Foundaon
Authorizaon Form for Recurring Gis
I(We)herebyauthorizeTennesseeTechnologicalUniversitytoiniatedebit/chargeentriesasstatedbelow.
Theautomacrecurringdebits/chargeswillbeprocessedonthe20thofeachmonth.
Name:________________________________________________________________Phone:_______________________________
Address:______________________________________________________City:_________________________________________
State:___________Zip:___________________E‐mail:______________________________________________________________
Designaon(s):___________________________________________________________Amount:____________________________
___________________________________________________________Amount:____________________________
___________________________________________________________Amount:____________________________
BeginningDate(Month/Year):______________________________
EndingDate(Month/YearorIndefinitely):_________________________________
RecurringAmount:____________________MonthlyQuarterlySemi‐AnnuallyAnnually
Credit Card:MasterCardVisaDiscover
CardNumber:________________________________________
NameonCard:_______________________________________
ExpiraonDate:________________CCV:__________________
Electronic Funds Transfer:
Pleaseincludeavoidedcheck.
NameofBank:_______________________________________
Thisauthorizaonis: Inaddiontoacurrentauthorizaon.
Anewauthorizaon‐nocurrentCCorEFTtransaconstoTTU.
Takestheplaceofpreviousauthorizaons.
Thisauthorizaonistoremaininfullforceandeffectunlthe ending date as indicated or unl Tennessee Technological University has
received wriennoficaon from the donor(s) of its terminaon in such me and manner as to allow Tennessee Technological University
reasonableopportunitytoactupontherequest.
Signature:__________________________________________________________________________Date:_____________________________
Office Use Only:
IDNumber:___________________________________________DevelopmentOfficer:____________________________________
AccountName(s):______________________________________FundNumber(s):________________________________________
______________________________________ ________________________________________
______________________________________ ________________________________________
____________________________________________________
Vice President, University Advancement Signature/Date
TN
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Tennessee Tech University Authorization Form for Recurring Gifts

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Completed 25 March 2020

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