Printable Gift Form

Dakota Wesleyan University Printable Gift Form
Please print this gift form and mail it along with your donation/pledge
to the address specified at the bottom of this page.

Name(s) as they should be listed on the gift receipt: Please print

______
Prefix _________________
First ______
Middle ________________________
Last ______________________
(Maiden)

Mailing Address _______________________________________________________

City______________________________ State___________ Zip Code________________

Telephone ( _____ ) _______________ E-mail address_______________________________

I am a:
Alumnus (a)
Grad year:
_______________ DWU Parent
Student’s Name:
_________________________ Friend


Gift Information (All gifts are deductible for tax purposes.)


A check for my gift of $___________ is enclosed. (Checks should be made payable to DWU.)


Please charge my gift of $___________________ to the following credit card:
Circle one: VISA    MASTERCARD    DISCOVER   Expiration Date: ____________

Account #: __________________________Signature: _______________________________


I wish to make _____ (#) payments of $ ______________ for a total of $ _______________
pledged. Please bill me in:

Jan.

Feb.

Mar.

Apr.

May

June

July Aug. Sept. Oct. Nov. Dec.



Gift Designation

Please credit my gift to the Wesleyan Fund

John Wesley Society
     $1,000 or more

Stewardship Society
     $500 to $999

Benefactor's Society
     $250 to $499

Founders' Society
     $100 to $249

Or credit my gift to the following fund:

Endowed/Annual Scholarship gift to:
______________________Scholarship

Other Gift:
________________________________

If your gift can be matched by your employer’s matching gift program, please check
with your personnel or benefits office for details and the proper form to enclose.

Please return this form, along with your contribution/pledge to:
DWU- Institutional Advancement
1200 W. University Ave.
Mitchell, SD 57301