Name(s)

Address

City State Zip

Phone Number

Email Address PLEDGE FORM3 E A S Y S T E P S

Check Credit / Debit Card Payroll Deduction

(EMU Employees Only)

Stock Transfer

See reverse to completegift information

CHOOSE YOUR WAY TO

GIVE

3CHOOSE YOURLEVEL OF

MEMBERSHIP

1

E - $100 - $499

A - $500 - $1,499

G - $1,500 - $2,499

L - $2,500 - $4,999

E - $5,000 - $9,999

S - $10,000+

Enter Gift Amount

Eagles Pride Fund

Sport Specific(Specify team)

Capital Projects

Program Endowments (Specify program)

Scholarships

CHOOSE YOUR AREA OF IMPACT

2

Select Designation

CONTRIBUTION OPTIONS Check enclosed (made out to the EMU Foundation)

Credit / Debit Card

One-time contribution

Monthly contributions

$ for (#) months

total gift of $

Visa Mastercard AmEx Discover

Account Number

Expiration Date

Name on Card

Payroll Deduction (EMU Employees only)

$ Per pay period

X Number of pay periods

$ My total pledge (minimum of $5 total)

EID (Your EID is required for payroll deduction. It can be found on your ID card or pay stub.)

Signature

Stock Transfer

Please contact me regarding a stock transfer.

The best time to reach me is

Matching Gift

Please contact me regarding a corporate matching gift.

The best time to reach me is

BENEFITS WAIVERI decline all benefits associated with my gift level and may therefore record my entire contribution as a tax deduction.

Signature Date

BENEFITS ACCEPTANCE I purchased, or plan to purchase football and/or basketball premium seating (80% of my gift is tax deductible)

Please contact me regarding Eagles Pride Suite seating. The best time to reach me is

Please contact me regarding Basketball Floor seating. The best time to reach me is

DIA15EAGPR