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					Central Gift Processing Gift Transmittal

Date: 12/27/09 Date of Gift:

Full Name of Person Preparing this Form: Phone #:

Foundation Receiving Gift: (select from this list) Appeal Code: (select from this list)
Donor Information

Advance ID #: Donor’s Full Name: Donor’s Address:

Social Security #: New Donor Name Change Address Change Matching Gift Information Company Name: On File Location:

Alumnus Faculty/Staff Student

Recognition (Soft) Credit Name: Advance ID #: RC Form Attached: Yes or Address (if not on Advance):

Matching Form Attached: (select)
Allocation/Account Name/Number: Gift Information Gift Amount: Tender: (select from this list) Made in: (select from this list)  (enter name here) <<< Attach a copy of your check here >>> Pledge: (select from this list)

OR <<< Fill in the credit card information below >>>

Credit Card #: Name (as it appears on the credit card): Expiration Date: Signature: _________________________________________________________________ Daytime Phone #:
Advancement Services – Gift Processing Box 7501, NCSU Campus, Raleigh, NC 27695-7501 Phone: 919-515-7827 / Fax: 919-513-2406 (revised: 3/03/03)


				
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