Smith College Staff Gift/Pledge Form
I, ________________________________________________________________ ID# (99) _______________
am pleased to make a gift/pledge to Smith College of _______________ for the following purpose:
_________________________________________________________________________________
In honor/In memory of:
___________________________________________________
Address:_______________________________________________________________________________
______________________________________________________________________________________
 I have enclosed full payment:
 Check
 Cash
 I wish to charge my credit card:
 For the full amount
 In payments as indicated below
 Master Card
 Visa
Card Number: ____________________________________________
Signature: _______________________________________
Name on Card:
Exp. Date: __________________
_______________________________________________________________________
 I wish to fulfill my pledge via payroll deduction:
Smith Identification (99) No.: _______________
Amount per Biweekly Pay Period: _______________
Total Pay Periods: _______________
 My pledge will be fulfilled according to the following schedule:
_______________
(Amount/Date)
 Matching Gift:
_______________
_______________
(Amount/Date)
(Amount/Date)
_______________
(Amount/Date)
______________________________________________
(please enclose form)
____________________________________________
Signature
_________________________
Date
Please return to: Gift Accounting; Stoddard Annex, Level I
Please call Kerri Saucier at ext.2032 with questions.
Thank you!