Automatic Bank Draft

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Please print this page. Complete the form, sign it, and mail it to:

Gift Accounting
Office of University Development
University of Virginia
P.O. Box 400807
Charlottesville, VA 22904-4807

If you have questions, please call (434) 924-7306

You may expect your gift deductions to begin within 30-45 days after this authorization has been processed and they will take place on or about the 10th day of each month. Your monthly bank statement will itemize this draft when it occurs. Gift receipt(s) will be issued from each area to which you have designated your gift.

Thank you for your generosity!

BIOGRAPHICAL INFORMATION

Your name:________________________________________________________________________________

Home Address:_____________________________________________________________________________

City:___________________________________________State:______________

Zip:_____________________

Home Phone:__________________   Business Phone:__________________

E-mail Address:___________________________________
BANK INFORMATION

I/We authorize the University of Virginia to initiate debit entries to my/our bank account established at the financial institution indicated below:

Financial Institution:_________________________________________________________________________

Address/Branch Office:____________________________________

City and State_______________________

Transit/ABA Number_________________________ Account Number_________________________________

Type of Account:     Checking      Savings

(YOU MUST ATTACH A VOIDED CHECK OR DEPOSIT SLIP)
GIFT DESIGNATION

I/We wish to make monthly gift payments of $_____________posting to my/our account.
For a period of:
 (please check one)		   6 months 12 months 24 months 36 months
or   Until I request that you stop  
 
For recognition in various Gift Clubs, the University operates on a fiscal year running from July 1 to June 30. Each monthly gift payment will be recognized in the fiscal year in which it is received.

Please direct this monthly gift to the following areas in these proportions:

____% School of Architecture
____% College of Arts & Sciences (College Foundation)
____% Graduate School of Arts & Sciences (College Foundation)
____% School of Continuing & Professional Studies
____% Curry School of Education Foundation
____% Darden School Foundation
____% Virginia Engineering Foundation
____% Law School Foundation
____% McIntire School of Commerce Foundation
____% School of Medicine (Medical School Foundation)
____% School of Nursing
____% UVA College at Wise Foundation

____% President's Fund for Excellence
____% University of Virginia, General Needs
____% Historic Buildings & Gardens
____% Non-Alumni Parents Program
____% University Art Museum (Bayly)
____% University Library
____% University Medical Center
____% Alumni Association of the University of Virginia
____% Virginia Athletics Foundation
____% Women's Center
____% Other (Please Specify):______________

________________________________________

ACCREDITATION
Should your spouse also receive credit for these gifts? Yes       No

MATCHING GIFTS
Many employees offer a matching gift program that can double or even triple your gift, and you will receive credit for your employer's contribution. To find out if your company or your spouse's company matches gifts, contact the company's human resources department or check this online company search.

Does your company match gifts? Yes      No

Company Name:__________________________________________________________________
AUTHORIZATION
This authorization will remain in full force and effect until the University of Virginia has received written
notification from me (or either of us) of its modification or termination in such time and in such manner as to afford the University of Virginia a reasonable opportunity to act on it.


__________________________________________________________________________________________
Signature

__________________________________________________________________________________________
Signature, if Joint Account

 
Development Home Page
Development Office Staff
Contact Us: 1-800-688-9UVA (9882)

Maintained by:
Last Modified:Friday, 10-Nov-2006 10:25:18 EST
© Copyright 2008 by the Rector and Visitors of the University of Virginia