BGSU Pledge Form – To Better the Man Fund

Name(s) ______________________________________________________________________________

Home address __________________________________________________________________________

City, State, Zip __________________________________________________________________________

Telephone (home) ___________________________ Telephone (work) ____________________________

Email address __________________________________________________ 

I commit to give or cause to be given a total gift of: $____________________over ___________years.

Check enclosed (check should be made payable to BGSU Foundation Inc.).   

Please charge my     VISA    MasterCard    American Express    Discover $_____________

Account number _________________________________________________ Exp. Date ______/_______ 

I wish to pay the remainder of my pledge in the following manner:

Credit Card

Please bill the credit card listed above to fulfill the remainder of this commitment (only for one year)

annually    quarterly   monthly    $_____________  beginning _______________.

 Electronic Funds Transfer

                  Amount                      Payment frequency       _______________________________________

                                                                                                                   (Financial Institution/phone number)                     

    $20                        monthly                               

    $25                        quarterly                                             _______________________________________

    $35                        annually                                                                            (Account Number)

   $______                continuous                             

                                                                                               _______________________________________

                                                                                                                          (Bank Routing Number)

    Checking        Savings

I (we) authorize the BGSU Foundation, Inc. to deduct my (our) contribution from the account indicated above on the 15th of the month.  I understand that if I decide to discontinue this plan I will notify the BGSU Foundation, Inc. at least two weeks prior.     ___________ (initials)

Check

Please send me a reminder invoice for $__________ every __________ month(s).

Matching funds from my company will be applied to my gift     Y    N

(Please consult your company's human resource department as there may be rules governing pledge payment matches)

                  Company Name:____________________________________                                 Match ratio: ___________

Signature: __________________________________________________        

Date: ____________________________

Please mail form to:             Gordy Heminge, Office of Alumni and Development     

                                                      Mileti Alumni Center

                                                      Bowling Green State University

                                                      Bowling Green, OH 43403