Annual Fund Pledge Form

	ANNUAL FUND PLEDGE FORM
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Make a pledge to Carlow's Annual Fund

Use this form to make a pledge to the Carlow Annual Fund if making payment by check, billing, or by gifting stocks or securities.

If you would like to make a gift using a credit card, you can give on-line through our secure server with your MasterCard, VISA, or Discover card.

To use the pledge form: type the appropriate information in each field or make a selection, then click the Submit button after you have completed the form. To move from one field to the next, press the Tab key on your keyboard, or relocate the cursor by "clicking" in the field with your mouse. If you encounter problems using this form, you can send e-mail directly to Lawna Blankenship ’97 & ’05 at Blankenshiplr@carlow.edu.

All items with an * (asterisk symbol) on this form are required and must be completed.

Annual Fund Pledge Form
Last Name*
First Name*
Middle Name
Maiden Name

Street*
City*
State*
Zip*
Country

Email
Phone

Undergraduate School
Graduate School

Spouse
Last Name
First Name
Is your spouse a Carlow alum?	Yes No

I want to make an Annual Fund pledge of* $5000 ; $1000 ; $750 ; $500 ; $250 ; $100 ; Other Amount ---> Please Enter Other Amount $

Your Tax Deductible Gift (Choose from the following payment options)*:
Check Please mail your check to this address
Bill Me Payment is appreciated by June 30^th
Stock/Securities Please call Anita Dacal at 412-578-6343 or 412-578-6120 to facilitate your gift.

Comments:

*Indicates a required field and must be completed to continue

Click Submit button to send your Carlow University your pledge.
Please be patient after you click Submit button; It may take a few seconds for the confirmation screen to appear.

Mailing Address:
Carlow University Annual Fund
6^th Floor Antonian Hall
3333 Fifth Avenue
Pittsburgh, PA 15213

If you would like more information, please contact:

Lawna Blankenship ’97 & ’05, Director of the Annual Fund
Email: Blankenshiplr@carlow.edu
Phone: 412-578-6654

Carlow University is accredited by the Middle States Commission on Higher Education, 3624 Market Street, Philadelphia, PA 19104. (267-284-5000)
The Middle States Commission on Higher Education is an institutional accrediting agency recognized by the
US. Secretary of Education and the Council for Higher Education Accreditation.