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CAL POLY

CENTER FOR SCIENCE AND MATHEMATICS

GIFT FORM FOR THE WESTERN COATINGS TECHNOLOGY CENTER

Thank you for making a gift to Cal Poly’s Western Coatings Technology Center in the Center for Science and Mathematics. All qualifying gifts will be recognized in university and college-wide publications. With a minimum gift of $3000, your name will be prominently displayed in the donor recognition area of the new building. Gifts can be paid over a five-year period if desired. Gifts can be met with a single donation or payments can be monthly or periodically as you specify. Your donation and participation at any level will be greatly appreciated.

Please specify your gift intent:

_____ Facility Naming Opportunity: Please see the WCTC Naming Opportunities

Amount of Gift: $__________ Named Facility:_______________________

_____ $15,000

_____ $10,500

_____ $6,000

_____ $3,000

_____ Other: Amount of Gift: $__________ (any gift, of any amount, will be helpful and appreciated)

My/Our gift will be in the form of:

cash credit card securities real estate gift in kind

Please specify method of payment:

One gift with payment enclosed

If credit card payment (please complete the following):

VISA Mastercard American Express

Name as printed on credit card _______________________________________

Credit card number __________________________ Exp. Date_____________

Signature__________________________________

Multiple gifts (not to exceed five years)

Payment(s) of $ ____________

to be made r monthly r annually r semiannually r quarterly.

beginning on _____________ (month) _____________ (day) _______ (year)

and ending on ____________ (month) _____________ (day) ________ (year)

Please send payment reminders

Please specify how you would like to be recognized on the donor recognition wall and in publications (examples: your name; your company’s name; name of family member; memoriam, etc.).

____________________________________________________

This is a pledge in company name:_______________________________________.

This is a pledge in my name only

This is a pledge in the name(s) printed below

Printed Name(s): __________________________________________________

Date: _______________________________

Signature:_______________________________________________________

Title:_________________________________________________________

Address:________________________________________________________

City/State/Zip:____________________________________________________

Phone/Fax/Email:__________________________________________________

Thank you for your commitment to Cal Poly!

Make your check payable to the Cal Poly Foundation

All contributions are tax deductible as permitted by law

For proper credit, please return this form with your gift to the Advancement Department in the College of Science and Mathematics, Bldg. 25, Room #339,Cal Poly, San Luis Obispo, CA 93407

Telephone: (805) 756-7375 E-mail: llarose@calpoly.edu

Foundation Tax ID#: 95-164-8180

08/08