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1. Donor Information (please complete)
2. Donation or Sponsorship Information (please complete)
3. For Office Use Only
Emplid: Campaign: Appeal: Designation: Program:
Charity: UWO UWO Fdn. Inc. UK Fdn. HK Fdn.
Advancement Services260 Westminster HallPhone: 519-661-4176Fax: 519-661-4182
Charitable Number#10816 2587 RR0001
Questions? Please contact Janice Van Der Klugt [email protected] or 519-661-2111 x85321
Donation (charitable receipt issued) Sponsorship (business receipt issued)
WHAT TYPE OF REMITTANCE?
One Time Gift Amount: $ (payment must be attached)
— OR —
Pledge Amount: $ Pledge payment: Pledge #:
Pledge Start Date: Payment Frequency: Pledge Period:
DO NODO NOT SEND CREDIT CARD PAYMENT INFORMATION VIA CAMPUS MAIL (PLEASE CONTACT X85321)
Fund Type: Gift Agreement: Yes No
Account: Fund: Org Code: Program or Project:
— OR — Speed Code:
Structural Theme:
Priority Project or Fund Name:
Named Gift Opportunity:
Gift Solicitor(s):Gift Solicitor(s):
Submitted By: Ext: Date Submitted:
Comments:
FOR FURTHER CLARIFICATION PLEASE VISIT GUIDELINES ON RECEIPTING
Yes
No
Donor: Emplid: Constituency Type:
Donor Recognition Name:
If Corporate, contact name is required for receipting:
Program: Anonymous: Soft Credit:Yes
NoEmplid:
No Emplid? Fill out this soft credit form.
PLEASE PROVIDE COPIES OF ALL DOCUMENTATION OR CORRESPONDENCE RELATED TO THE GIFT