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UCLA Procedure 191.0 : Attachment D

Sample Gift and Mmbership Solicitation Remittance Templates

BASIC GIFT REMITTANCE CARD*

 

Front of Basic Gift Remittance Card

I am pleased to support the (Name of School, Dept., Center) with my gift to (Fund Name) in the amount of:

[  ] $2,000     [  ] $1,500     [  ] $1,000     [  ] Other $______

[  ] This is a joint gift. Spouse/Partner name: __________________________________

Method of Payment:  prefer to pay by:

[  ] Check: Please make check payable to The UCLA Foundation.

[  ] Credit Card: [  ] VISA     [  ] MasterCard     [  ] American Express     [  ] Discover

Credit card #: ____________________________________________________________

Expiration (mm/yy): _______________________________________________________

Name on card (please print): _____________________________________________________

Amount to be charged now: $_______________________________________________

If you would like to make your gift over time, please check one from each of the following categories:

First payment: (select one)

Included

To be made: _______
                      (mo/yr)


Payment Schedule: (select one)

[  ] One-time payment on:
_______
(mo/yr)

[  ] 2 semiannual payments

   
  
[  ] 4 consecutive
monthly payments

[  ] 4 quarterly payments

For my convenience, please automatically deduct my pledge payments on the 15th of the month(s) in accordance with the payment schedule selected above from my:

[  ] Credit card (as completed above)

[  ] Checking account (please include your first payment or attach a voided check showing name, address and account number to be charged)


Signature:_________________________________________ Date:_______________________


Additional ways to give:

[  ] Matching Gift: In addition to my personal gift, I have enclosed a matching gift form.

[  ] Estate Plan: Please send me information on how I can include UCLA in my estate plan.

   Online: To give online, visit www.campaign.ucla.edu.

   Securities: Please contact the securities coordinator at (310) 794-3434 for detailed transfer instructions.

[  ] Please update my contact information (make changes on reverse).

(Advance ID)
Josephine Bruin ’76 (Phone)
1234 Westwood Blvd. (E-mail address)
Los Angeles, CA 90024


(Phone Number)
(E-mail Address)

Please send payment and this completed form in the enclosed envelope to: The UCLA Foundation, Box 7145, Pasadena, CA 91109-7145 (Do Not Send Cash). For more information, please call: (Solicitation Initiator) at (Initiator’s Phone number).

Thank you for your tax-deductible gift in support of (Name of School, Dept., Center)

I.D.# 0001234567 #1234 AC101

Back of Basic Gift Remittance Card

Please help us update your information:

Name:__________________________________ Preferred Address Position/Title_______________________________
Address_________________________________ [  ] Home   [  ] Business Company Name_____________________________
________________________________________   Company Address___________________________
    __________________________________________
Home Phone_____________________________ Preferred E-mail Business Phone:____________________________
Home E-mail______________________________ [  ] Home   [  ] Business Business E-mail:_____________________________

Date of Birth: ___/___/________
Marital Status:____________________________

Please help us update your spouse/partner's information:
Is spouse/partner a UCLA alumnus?     [  ] Yes    [  ] No
Name of spouse/partner:____________________ Name at graduation:_____________________   Class year:_____

Privacy Notice: The 1977 California Information Practices Act requires UCLA to inform individuals asked to supply information about themselves of the following: UCLA is requesting this information to update the general resource files of its External Affairs Department. Furnishing the information is strictly voluntary and will be maintained confidentially. The information may be used by other University departments in the regular course of business but will not be disseminated to others except if required by law. You have the right to review your own data file. Inquiries should be forwarded to Assistant Vice Chancellor - Finance and Information Management, External Affairs, 10920 Wilshire Blvd. 9th Floor, Los Angeles, CA 90024-6511. Donor's Consent to Use Personal Information: The University is grateful for the support it receives from alumni, parents, and friends. One of the ways we express our thanks is by listing the names of donors in Web-based and/or print publications. Should you wish that your name not appear as a donor, please notify us if you have not already done so. Fiduciary Responsibility of The UCLA Foundation: The UCLA Foundation is a California non-profit, public benefit corporation organized for the purpose of encouraging voluntary private gifts, trusts and bequests for the benefit of the UCLA campus. Responsibility for governance of The Foundation, including investments, is vested in its Board of Directors. Recovery of Operating Costs From Private Gifts: As is customary with universities and other non-profit organizations across the country, a one-time gift fee is applied to all gifts to provide essential support necessary to UCLA's overall operation. The fee is currently 6.5%. Automatic Payment Plan Agreement: I hereby authorize The UCLA Foundation (Company ID# 95-2250801) to initiate monthly debit entries for my remaining payments and (credit) adjustments for any debit entries in error to my designated checking or credit card account. This authority is to remain in effect until the balance has been fulfilled or until the Bank receives written notification from me of its termination in such time and in such manner to afford Bank reasonable opportunity to act.

*This is a basic gift remittance card for The UCLA Foundation with one fund and multiple payment options.

Other remit templates will allow for solicitations with giving to:

  • Multiple funds

  • Benefits (acceptance/decline)

  • Memorial /honorary tributes

  • Endowed funds

  • Medical Sciences (HIPAA disclosures)

  • Multi-year

 

BASIC MEMBERSHIP REMITTANCE CARD**

Front of Membership Remittance Card

Membership Options (choose one):

(LM) [  ] Life Membership: $495 (paid in full)

(PL) [  ] Life Membership Easy Payment Plan: Pay $55 now as an initial down payment, then have $27.50 per month deducted from your checking or credit card account for 18 months - a total cost of $550

Authorization signature:_____________________________________  Date:______________

(AM) [  ] Annual Membership: $45

Method of Payment  I prefer to pay with my (choose one):

[  ] Check: Please make check payable to the UCLA Alumni Association.

[  ] Credit Card: [  ] VISA      [  ] MasterCard      [  ] American Express      [  ] Discover

Credit Card #:_________________________________________

Expiration (mm/yy):____________________________________

Name on card (please print):__________________________________

To join online, visit www.UCLAlumni.net.

Please update my contact information (make changes on reverse).

(Advance ID)
Josephine Bruin ’76 (Phone Number)
1234 Westwood Blvd. (E-mail address)
Los Angeles, CA 90024


(Phone Number)
(E-mail Address)

Please send payment and this completed form in the enclosed envelope to: UCLA Alumni Association, Box 512625, Los Angeles, CA 90051-0625 (Do Not Send Cash). For information, please call: Members Services at 800- or 310-UCLAlumni (825-2586).

Thank you for joining the UCLA Alumni Association.

I.D.# 0001234567 AM-FRAM PL/LM-FRAM/CASE AC101

Back of Membership Remittance Card

Name:__________________________________ Preferred Address Position/Title_______________________________
Address_________________________________ [  ] Home   [  ] Business Company Name____________________________
________________________________________   Company Address___________________________
    ___________________________________________
Home Phone_____________________________ Preferred E-mail Business Phone:____________________________
Home E-mail______________________________ [  ] Home   [  ] Business Business E-mail:_____________________________

Date of Birth: ___/___/_______
Marital Status:____________________________

Please help us update your spouse/partner's information:
Is spouse/partner a UCLA alumnus?     [  ] Yes    [  ] No
Name of spouse/partner:____________________ Name at graduation:_____________________   Class year:_____

Online Directory: Members are automatically included in our Online Alumni Directory unless they ask to be excluded.

      [  ] Please exclude the following from my listing (check below):

(XA) [  ] Home Address      (XE) [  ] Home E-Mail      (XB) [  ] Business Information

(XP) [  ] Home Phone         (XG) [  ] Graduation Year

(XT) [  ] Please exclude me from the Directory.

Automatic Payment Plan Agreement: I hereby authorize the UCLA Alumni Association (Company ID# 95-2286986) to initiate monthly debit entries for my remaining payments and (credit) adjustments for any debit entries in error to my designated checking or credit card account. This authority is to remain in effect until the balance has been fulfilled or until the Bank receives written notification from me of its termination in such time and in such manner to afford Bank reasonable opportunity to act.

**This is a basic membership remittance card for The Alumni Association solicitation for Alumni and Friends.

Other remittance templates will allow for solicitation of:

  • Students

  • Alumni class year