printable donation form - NC AWWA-WEA

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NC AWWA-WEA Safe Water Endowment
Donor Program
NC AWWA-WEA * 3725 National Drive, Suite 217 * Raleigh, NC 27612
919-784-9030 x 240 * www.ncsafewater.org
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NC AWWA-WEA Safe Water General Endowment
Crowder Construction Company Scholarship
Frank and Susan Stephenson Scholarship Fund
Lars Balck Fund
Raftelis Financial Consultants Scholarship
Carol Bond Fund
Environmental Manufacturer’s Representative Scholarship
GHD Clean Water Fund
Les and Elaine Hall Water Environment Stewardship Fund
Raftelis Foundation Elementary Education Scholarship
Rivers & Associates Fund
I am interested in establishing a named fund ($25,000 minimum)
Payment Methods
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I would like to make a donation by check or credit card:
Amount Enclosed is
$___________________
Check number:
Credit Card # _______________________________Security Code # _______Exp. Date: Month &Year:_______
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I would like the amount of my donation to be undisclosed
I would like my name to be kept anonymous
My Company has a matching funds program (Name):
I would like to make a stock transfer
Amount is approximately
$___________
I would like to meet with the Endowment’s Foundation Partner to discuss other gifts.
I would like to set up a pledge of $____________ over a _____ year period.
__________Annually
The first payment of $___________________is enclosed.
Please make your check payable to “NC AWWA-WEA”
Also, if you have selected a particular fund, please write the name of the fund on the memo line of the check.
If paying by credit card, please be sure that name and address list below are the same as those for the credit card
Date:
Printed Name:
Signature:
Address:
Phone:
E-Mail:
Return to: NC AWWA-WEA, 3725 National Drive, Suite 217, Raleigh, NC 27612
Questions: Marianne Keser, 919-784-9030 x 240, mkeser@ncsafewater.org
NC AWWA-WEA Safe Water Endowment
Donor Program
NC AWWA-WEA * 3725 National Drive, Suite 217 * Raleigh, NC 27612
919-784-9030 x 240 * www.ncsafewater.org
Individual Pledge Amounts and Durations
Pledge Amount
Paid off by
Less than $500
Immediately
$501 - $1,000
1 year (by year end)
$1,001 to $2,000
2 years (one annual payment each year for 2 years)
$2,001 to $3,000
3 years (one annual payment each year for 3 years)
$3,001 to $4,000
4 years (one annual payment each year for 4 years)
Over $4,000
5 years (one annual payment each year for 5 years)
Pledge Amount
Levels of Corporate Giving
Category
$ 5,000 - $9,999
Swift Streams
$10,000 - $14,999
Roaring Rivers
$15,000 - $24,999
Great Lakes
Mighty Oceans
NOTE: At this level, you may also name your own fund
$ 25,000 and above
Note:
After initial payment, remaining balance for all pledges will be invoiced annually in equal amounts, but remaining balance
may be paid by the donor in full at any time.
Should the Board approve a named fund for which pledge payments are offered over a period of time to achieve the
$25,000 minimum, the Donor shall acknowledge that, should donations fail to reach the minimum of $25,000 within the
prescribed time, the Board shall have the right to eliminate the named fund, and transfer any funds contributed either to
the NC Safewater Fund, or to any other of NC AWWA-WEA’s named funds, at the Donors discretion.
Return to: NC AWWA-WEA, 3725 National Drive, Suite 217, Raleigh, NC 27612
Questions: Marianne Keser, 919-784-9030 x 240, mkeser@ncsafewater.org
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