13567

GIVING.PURDUE.EDU/TJF

GIFT/PLEDGE FORM
I/We would like to make a gift today to Purdue University.
Total Gift Amount:

Please designate my gift as indicated below:

(Gifts of $1,000 or more qualify for President's Council.)

This gift will be matched by my company:

Company:

$
$

Allen County Area Assistance Fund (021542)

Other:

(Please contact your company HR office for matching procedures.)

My Information:

Spouse Information:

Name:
Address:
City:
State:
Zip:
Telephone:
Cell phone:
Alumna/us:
YES
NO
Major/Year:
Name at Graduation:

Name:
Address:
City:
State:
Zip:
Telephone:
Cell phone:
Alumna/us:
YES
NO
Major/Year:
Name at Graduation:

Gift/Pledge Payment Information:

(Made payable to Purdue Foundation)
Check
Credit Card
I/We authorize Purdue University to charge $_______________ to my:
Visa
Master Card
Discover
American Express
Card Number:
Expiration Date:
Sec. Code:
Print name as it appears on card:
Billing address if different from above:
Signature:

Date:

Pledge
I/We intend to make a total gift of $_____________________
First payment date:
It is my/our desire to pay this pledge over a period of __________ years.
Please remind me/us:
annually
semi-annually
quarterly
Signature:
Please mail this form and your payment to:
Purdue Research Foundation
403 West Wood
West Lafayette, IN 47907-2007

monthly

Date:
Questions?
Contact Tanya Finkbiner
Director of Development
College of Veterinary Medicine
Call 765-494-5032 or e-mail tjfinkbiner@prf.org

A message from the Purdue Research Foundation, an independent organization that acts for the benefit of Purdue University.

Thank you!