MAJOR GIFTS CAMPAIGN
You are encouraged to make your gift in the form of a pledge
which may be paid over a five year period.
(Please print)
Name: _____________________________________________________________
Address: ____________________________________________________________
City: __________________________
State: _________ Zip Code: _________
Telephone: ____________________________
Signature: ___________________________________ Date: _________________

CASH OPTION
I/we pledge: $__________ over a period of _____ years, starting ________________.
Enclosed: $_________ Remainder $ ________ to be paid as follows:
Please indicate method of payment:
 Payroll deduction of $__________ per month (SS# _ _ _ - _ _ - _ _ _ _)
 Payroll deduction of $__________ per quarter (SS# _ _ _ - _ _ - _ _ _ _)
 Payroll deduction of $__________ annually
(SS# _ _ _ - _ _ - _ _ _ _)
 Check or cash
 Credit Card
 VISA
 MasterCard
 Discover
Print name as it appears on credit card: ____________________________________________________
Credit Card Number: ________________________________________ Expiration Date: _____________
Telephone Number: ___________________________________

NONCASH OPTION
Type of Gift: ________________________________________________________________
Please use this gift for one of the following:

Nursing/Biotechnology Facility

Technology Needs

Student Scholarship Endowment

Faculty and Professional Staff Development Endowment

Where the need is greatest
Please make your gift payable to Southwest Foundation.
Your gift is tax deductible to the extent of the law.