Page 13 - Delta Chi - Georgia Tech - Campaign Advance Packet

Campaign Pledge Agreement Non-Deductible (less than $2,500) I, ________________________________, accept the invitation to join my brothers and hereby do pledge and agree to contribute the sum of $___________________ as part of the Building For The Next 25 Years Campaign for 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) } ________________ m Semi-annually years 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 HOUSE CORPORATION. Please send this Pledge Agreement to: For further information, please contact: DELTA CHI HOUSE CORPORATION 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