Electronic Gift Transfer Authorization Form

Electronic Gift Transfer Authorization
I(We) first and last name(s)* hereby authorize my financial institution to pay and charge to my account by the University of South Carolina Foundations in the amount of
$donation amount* per month. I(We) understand that the electronic gift transfer will remain in effect until a written notification to terminate this authorization is submitted. Notification to terminate must be received at least 30 days prior to the date the electronic gift transfer(s) are to be discontinued.
Name on Account:*

First NameLast Name
Name on Account (if joint account):

First NameLast Name
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred E-mail Address:*
example@example.com
Phone:*
Please enter a valid phone number.
Secondary Phone:
Please enter a valid phone number.
Name of Financial Institution:*
Address of Financial Institution:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Account Number:*
Routing Number:*
I would like my monthly gift to support the:*

Carolina FundArnold School of Public HealthCollege of Arts & SciencesCollege of EducationCollege of Hospitality, Retail, & Sport ManagementCollege of Information and CommunicationsCollege of NursingCollege of PharmacyCollege of Social WorkDarla Moore School of BusinessJoseph F. Rice School of LawMcNair Institute for Entrepreneurism and Free EnterpriseMolinaroli College of Engineering and ComputingPalmetto CollegeSchool of Medicine - ColumbiaSchool of Medicine - GreenvilleSchool of MusicSouth Carolina Honors CollegeThe Graduate SchoolUniversity LibrariesUSC AikenUSC BeaufortUSC LancasterUSC SalkehatchieUSC SumterUSC UnionUSC Alumni AssociationParents FundOther (see below)
If none of the above choices apply, please choose one of the below options:
Reunions: Class of YYYY
Other:
Please use multiple forms if you wish to support more than one area.
Signature:*

Clear
Date:*

MonthDayYear
Signature (if joint account):

Clear
Date (if joint account):

MonthDayYear
Other Information:

AlumnusParentFaculty/StaffFriend
Your gift deductions will begin within 30-45 days after this authorization has been processed and will take place on or about the 15th day of each month. Your monthly bank statement will itemize this draft when it occurs. Gift receipt(s) will be issued for each designation that is to benefit from your gift.
Many thanks for your continued generosity.
Should be Empty:

Electronic Gift Transfer Authorization

Many thanks for your continued generosity.