Page 12 - Delta Chi - Georgia Tech - Campaign Advance Packet

Campaign Pledge Agreement Tax-Deductible (gifts $2,500 and up) I, ______________________________________________, accept the invitation to join my brothers and hereby do pledge and agree to contribute the sum of $______________________ to the Delta Chi Foundation as part of the Building for the Next 25 Years Campaign for the beneft of Delta Chi at the Georgia Institute of Technology. My gift will be paid in the following manner: m One-time payment Plan to be paid over m Quarterly (Jan/Apr/Jul/Oct) } ________________ years m Semi-annually m Annually [Maximum 5 Years] m Stock (publicly traded) m Other: m I am affliated with a company that has a matching gift program. Employer: Start Date (please select one): m January m April m July m October 20 Signature: Date: Print Name: Graduation Year: Preferred Address: City: State: Zip: Home Phone: Work Phone: Cell Phone: E-mail: Payment Method: Gift to be made: m Check m Stock (publicly traded) m In my name as printed above m Credit Card: ____ Visa ____ MC ____ AMEX ____ Discover m Anonymously m In honor of: Credit card payments will be automatically deducted according to the payment schedule. m In memory of: Please select one: m monthly m quarterly m semi-annually m annually Account No.: Exp. Date: Signature: Note: Please make check payable to DELTA CHI FOUNDATION. Please send this Pledge Agreement to: For further information, please contact: DELTA CHI FOUNDATION Kyle Taylor, Account Manager Campaign Headquarters T: 770-903-3987 F: 770-903-3988 P.O. Box 80828 | Atlanta, GA 30366-0828 E: ktaylor@thelaurusgroup.net