A GIFT FOR MSU...
Revised: 5/2010
PLEDGE FORM
I/We wish to contribute $________________
in the following manner (fill in all that apply):
Immediately in cash, securities,
or real properties. . . . . . . . . . . . . . . . . . . . . $_________________
Immediately as a credit card charge. . . $________________
MasterCard
Visa
AMEX
Discover
Card #:____________________________
Expiration date:_ ___________________
Name on card:_ ____________________
This is a joint gift with my spouse/significant other.
This contribution should be credited to my individual record.
This contribution is designated as follows:
Unrestricted for the area of greatest need across MSU.
Designated each year as gifts are made.
Designated as follows (indicate dollar amount to each area):
_____________________________________________________
_____________________________________________________
Please check one of the following:
This pledge is in addition to any other existing pledges to MSU.
This pledge replaces all other existing pledges to MSU.
Annual amount of $_ _______________
over________ years, totaling. . . . . . . . . . $_________________
Starting in the year:_ _______________
I/We understand that any pledge we make is not legally binding
upon individuals or their estates.
Name:_ _______________________________ Date:__________
I/We prefer to make annual contributions in the month(s) of:
Jan Feb Mar Apr May Jun
Jul Aug Sep Oct Nov Dec
Annual corporate match $___________
over_ _______ years, totaling. . . . . . . . . . $_________________
A planned gift in the (approximate)
amount of. . . . . . . . . . . . . . . . . . . . . . . . . . . . $________________
Other (please specify)_ _________________
_________________________________
TOTAL CONTRIBUTION $________________________
Name:_ _______________________________ Date:__________
Signature:_ ___________________________________________
MSU FACULTY/STAFF payroll deduction only
Deduct my pledge in equal monthly installments of $_________ ,
totaling $________ annually, beginning (month/year)_______
ZPID#_____________________________________
(Signature and ZPID required for payroll deduction.)
Pay group: Salary Labor Grad AY Faculty (8 installments)
If applicable, please select the Donor Society in which your pledge will qualify for recognition; cash pledges are payable over five years:
Presidents Club
$10,000 cash with minimum annual contribution of $2,000
Robert S. Shaw Society
$500,000 cash or $1,000,000 planned
Beaumont Tower Society
$25,000 cash with minimum annual contribution of $3,000 or
20% of the original pledge amount, whichever is greater
Frank S. Kedzie Society
$1,000,000 cash or $1,500,000 planned
John A. Hannah Society
$50,000 cash with minimum annual contribution of $5,000 or
20% of the original pledge amount, whichever is greater, or a
planned gift of at least $100,000
Signature:_ ___________________________________________
Clifton R. Wharton Society
$2,500,000 cash or $3,750,000 planned
Joseph R. Williams Society
$5,000,000 cash or $7,500,000 planned
Jonathan L. Snyder Society
$100,000 cash or $200,000 planned
William J. Beal Society
$10,000,000 cash or $15,000,000 planned
Theophilus C. Abbot Society
$250,000 cash or $500,000 planned
Linda E. Landon Society
All documented planned gifts, any size
Desired form of listing for all relevant donor recognition, including donor memento and honor rolls
(i.e. Dr. & Mrs. John Doe, John and Mary Doe, etc)______________________________________________________________________________
- Over -
Date:__ ______________________
CONFIDENTIAL BIOGRAPHY (please print clearly)
NAME
SPOUSE OR SIGNIFICANT OTHER
_______________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________________
________________________________________________________________________________
College/University:___________________________________________
College/University:______________________________________
Year:_______ Degree:_ _______ Major:_ __________________________
Year:_______ Degree:_________ Major:______________________
College/University:___________________________________________
College/University:______________________________________
Year:_______ Degree:_ _______ Major:_ __________________________
Year:_______ Degree:_________ Major:______________________
Social Security #:_____________________________________________
Social Security #:________________________________________
Birth Date:__________________________________________________
Birth Date:_____________________________________________
Preferred e-mail:_____________________________________________
Preferred e-mail:________________________________________
Cell Phone:_ ________________________________________________
Cell Phone:_ ___________________________________________
RESIDENCE
SEASONAL RESIDENCE
Street Address:______________________________________________
Street Address:________________________________________
City:________________________ State: _______ Zip:________________
City:________________________ State:________ Zip:_________
Country:_ __________________________________________________
Country:_ ____________________________________________
Phone: _ ___________________________________ Ext.:_ ___________
Phone:___________________________________ Ext.:_________
Fax:_ ______________________________________________________
Fax:_ ________________________________________________
Title, First Name, Middle Name, Last Name
Nickname
Maiden Name
Title, First Name, Middle Name, Last Name
Nickname
Maiden Name
Dates Applicable: From:_______________ To:________________
BUSINESS
SPOUSE OR SIGNIFICANT OTHERS BUSINESS
Title:_______________________________________________________
Title:_________________________________________________
Company:__________________________________________________
Company:____________________________________________
Street Address:______________________________________________
Street Address:________________________________________
City: _______________________ State:________ Zip:________________
City:________________________ State:_ _______ Zip:_________
Country:_ __________________________________________________
Country:_ ____________________________________________
Phone: _ ___________________________________ Ext.:_ ___________
Phone:___________________________________ Ext.:_________
Fax:_ ______________________________________________________
Fax:_ ________________________________________________
Please remember to complete section D on the reverse side of this form.
OTHER INFORMATION
Please send me information on making a planned gift to MSU.
I/We prefer to receive mail at my/our Residence(s) Business
Please make checks payable to Michigan State University and return to:
University Advancement
300 Spartan Way
East Lansing, Michigan 48824-1005
Names and birth dates of children
(please indicate MSU graduation or attendance dates if applicable)
__________________________________________________________
For questions, call 517-884-1000, 8 a.m. to 5 p.m. EST, Monday-Friday, or
__________________________________________________________
visit our website at www.givingto.msu.edu.
Campus organizations, memberships, professional association
memberships and additional significant information about you or your
family that you would like to share
Office use only
Staff Responsible:______________________________________
__________________________________________________________
Donor ID(s):___________________________________________
__________________________________________________________
Appeal Code:_ _____________________________ Autoqualify
