Pledge Form
Pledge Form
Date Created
Date Created
/
MM
/
DD
YYYY
Requester Name
Requester Name
*
First
Last
UTD Email
*
UT Dallas Phone
UT Dallas Phone
-
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-
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School/Unit
A&H
Ackerman
Alumni
Asia Center
Athletics
BBS
Callier
CBH
Corporate
CVL
ECS
Endowment
EODIAH
EPPS
Foundation
Library
JSOM
NS&M
Planned Giving
Other
if other, please explain
Pledge Information
Pledge for Individual or Organization
*
Individual
Organization
Is this for an Endowment?
*
Yes
No
Is there a Gift Fundraiser(s)?
if so please enter
Constituent ID
*
Donor Name
Donor Name
Title
First
Middle
Last
Suffix
Spouse Name
Spouse Name
Title
First
Middle
Last
Suffix
Organization Name
Contact Name
Contact Name
Title
First
Middle
Last
Suffix
Contact Title/Position
Contact Type
Is there a Current Proposal/Opportunity
*
Yes
No
Proposal/Opportunity Name
Purpose/Designation
Cost Center Name
if you don't have a cost center, use 11050002, Development Holding
Cost Center Number
Pledge Installment Information
Total Gift Amount
*
$
Dollars
.
Cents
(please do not use commas)
Pledge payment schedule
such as:
1 payment on 7/1/2018
3 annual payments
12 monthly payments
*
Pledge payment amount
*
$
Dollars
.
Cents
please do not use commas
Pledge Start Date
Pledge Start Date
*
/
MM
/
DD
YYYY
Notes
Upload confirmation of donor's pledge
(i.e. email/letter from donor, signed gift agreement)
*
Attach Files