Gift Form

Please print this page and complete the required information. Upon completion, you may do any of the following:

Mail form and payment to: UT Martin Development Office
328 Administration Building
Martin, TN 38238

Fax form back to us at: (731) 881-7654

Call to speak to a Development Officer at: (731) 881-7620.


	Name:______________________________________________________________


	Address: ______________________________________________________________


	City: ___________________

State: _________

Zip: ________________


	Home Phone: (____) _____ - __________

Work Phone: (____) _____ - __________


	My gift of $__________ is enclosed. Please designate it for: _____________________________


	I pledge $___________ a year for ______ year(s) for a total of $____________________


	Please remind me ___ semi-annually ___ annually


	*Checks should be made payable to the University of Tennessee at Martin*

Visa ____


	For payment by credit card, please complete the following:


	Mastercard ____


	Discover ____


	Payment Amount $_____________


	Account # ____/____/____/____/____/____/____/____/____/____/____/____/____/____/____/____