Planned Gift Option. I am interested in learning more about gift options
such as wills, trusts, estates, annuities or other planned giving options.
Is Lipscomb University in your will? Yes No Would consider
I want my gift to benet the following area at Lipscomb University (select one):
Lipscomb Fund - Area of Greatest Need $ __________________________ Other: $ _____________________________
General Scholarship Fund $ __________________________ (please specify) _____________________________
College/Institute $ __________________________
(Please specify) ____________________________ TOTAL GIFT AMOUNT: $ __________________________
Yes, I want to make a gIft to LIpscomb UnIversItY!
gIft form
First Name ______________________________________ MI _____ Last Name ___________________________________________
L# (if known) ___________________________ Personal Email _________________________________________________________
Spouse First Name ______________________________SpMI _____ Spouse Last Name____________________________________
Address _____________________________________________________________________________________________________
City, State, ZIP ________________________________________________________________________________________________
Home # ( ) ______________________ Work # ( ) ________________________ Mobile # ( ) _____________________
Please print
I am: (Please check all that apply)
Student Alumnus Parent
Grandparent Friend Other
Home Mailing Business
Account # ___________________________________________________
Exp. Date ____________________________________________________
Printed Name ________________________________________________
Charge my gift to:
Please charge my card:
full amount OR $______ each: month quarter year
(as appears on card)
Automatic Bank Draft
I hereby authorize Lipscomb University to initiate monthly
bank drafts in the amount stated below
for the number of months indicated.
$ ______________ each month for _____________months, beginning_________________ .
I prefer bank drafts posted to my account on the (select one)
4th 19th of each month.
# of months
To register for automatic bank draft:
1. Please print this form
2. Fill out your name
3. Fill out the bank draft information
4. Sign your name in the space provided
5. Mail this form with a voided check to:
Lipscomb University,
One University Park Drive,
Nashville, TN 37204-3951
Name: ______________________________________________ Signature: _____________________________________________
Form must include your printed name and signature for processing. Thank you!
Check made payable to: Lipscomb University
Make recurring gift. Please automatically renew
this gift on the gift anniversary date.
paYment method
Honor/Memorial Gifts:
This gift is in: Honor of Memory of
Name: __________________________________________________
For Honor and Memory gifts, please notify:
Name ___________________________________________________
Address _________________________________________________
City, State, ZIP ____________________________________________
Matching Gift Option.
My employer has a matching gift program: Yes No
Company name: _________________________________________
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