Printable Form Only
GIFT/PLEDGE FORM FOR THE
Thank you for making a gift or pledge to the
Please designate my/our gift pledge of $__________________ to:
The Center for Science and Mathematics
The
Other ___________________________________
My employer matches gifts. (Please contact your personnel office for instructions.)
My/Our method of payment will be:
as one gift
payment of $_____________ enclosed
credit card payment (please complete the following):
VISA Mastercard American Express
Name as printed on credit card _______________________________________
Credit card number __________________________ Exp. Date_____________
Signature_________________________________________________________
as a pledge of $______________ payable up to five years ($3,000 minimum, please)
Payment(s) of $ ____________
to be made monthly annually semiannually quarterly
beginning on _____________ (month) _____________ (day) _______ (year)
and ending on ____________ (month) _____________ (day) ________ (year)
Please send payment reminders.
This is a contribution in my name only.
This is a contribution in the names printed below.
Printed Name(s) __________________________________________________
__________________________________________________
Date ___________________________________________________________
Signature _______________________________________________________
Address ________________________________________________________
________________________________________________________
City/State/Zip ____________________________________________________
Phone __________________________________________________________
Fax ____________________________________________________________
Email __________________________________________________________
Please make your check payable to the Cal Poly Foundation.
For proper credit, please return this form with your gift to the Advancement Department in the,
College of Science and Mathematics, Cal Poly,
Telephone: (805) 756-7375 E-mail: llarose@calpoly.edu
Foundation Tax ID#: 95-164-8180