PRINTABLE GIFT FORM MY INFO: Name:______________________________________ Spouse:___________________________________________ Home Address:_______________________________ City:_________________________State:_______Zip:________ Email:_______________________________________ Home Phone:______________________________________ Cell Phone:___________________________________ UTEID: ___________________________________________
GIFT INFO: Designation:
U TSA Fund supports the areas of greatest need Scholarships The College of: _____________________________ Other: __________________________________________
My (or my spouse's) employer will match this gift!
Matching gift form enclosed
This gift is in honor of:____________________________________________ This gift is in memory of:__________________________________________ I'd like to learn more about: President's Associates
Planned Giving
PAYMENT INFO: Gift Amount: ______________________ Cash or Check Enclosed please make checks payable to "The University of Texas at San Antonio"
Visa Mastercard
Discover
American Express
Card Number:____________________________________________
RETURN TO: Gift Services External Relations One UTSA Circle, San Antonio, TX 78249
Exp Date:__________________ Security Code: _________________ Please bill my credit card in ______ installments Payroll Deduction: Amount of gift each paycheck $ ________
QUESTIONS? giving@utsa.edu or 210-458-4130
Signature:______________________________ Date:___________ Note: Payroll deduction will remain in effect until revoked in writing by the employee to the Gift Services office. An annual statement of your gifts will be automatically provided to you for tax purposes in January. Your contribution is tax deductible to the extent allowed by law. Please consult with your tax advisor for further information.
For Gift Services Office Use Only Original must be fowarded to Payroll Office with a copy for processing purposes. Date received: __________
End Date: __________
Date forwarded to UTSA: _________________________