SLCC FOUNDATION Contribution Form

Give to SLCC

Name *

Prefix First Name Last Name

Company Name *

(If not applicable, please type "None")

Phone Number

E-mail *

What is the purpose of your gift? *

Highest Priority Need College Innovation Fund Student Success and Scholarships Other

If you selected "Other," please indicate the gift purpose in the box below. If appropriate, please include the name of the individual(s) for which this gift is associated.

Choose Your Donation Method *

Credit Card Direct Deposit Authorization (ACH)

I would like to invest in SLCC at the following level. *

Donation $ 2,500.00

Donation $ 1,000.00

Donation $ 750.00

Donation $ 500.00

Donation $ 250.00

Donation $ 125.00

Donation $ 50.00

Donation $ 25.00

Other Amount for SLCC Donation $ 1.00

Amount ($)

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

I would like to invest in SLCC at the following level. *

$2500.00 Donation $1000.00 Donation $750.00 Donation $500.00 Donation $250.00 Donation $125.00 Donation $50.00 Donation $25.00 Donation

How often would you like your contribution to be drafted?

one time monthly (recurring) quarterly (recurring) semi-annually (recurring) annually (recurring)

For recurring contributions, please select the date when you would like us to stop drafting your account. If this field is left blank, we will continue drafting your account until you notify us to discontinue the drafts.

Date

Name(s) on Bank Account (business name if used) *

Address Associated with Bank Account *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Routing Number *

must be 9 numbers - no spaces

Account Number *

Bank Name *

Bank Branch *

City, State

Bank Phone Number *

Signature - I authorize Community Foundation of Acadiana (CFA) to draft my account as specified above. *

Clear