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Mail in Payment with Online Form

* Designates a required field.

1. Enter your contact information:
Name
 First *
Last *
Title (Mr, Ms)
If you are married, please write your married name exactly as you want it to appear in Drake's records. Please indicate your unmarried surname in parentheses if it is no part of your married name.
Banner ID


To assure accuracy we us this number to identify you in our database, you can find this 9 digit number above your name and address on your copy of Drake Blue. Not required.
College & Year
 * , *
Birth Date * mm/dd/yyyy
Street Address
 *
City
 *
State/Provence
 *
Zip
 *
Country
 *
Email Address
 *
Phone (Home)
 *
Phone (Work)
Employer
Title

 

2. Choose the area(s) your contribution will support:
Where needed most $
Cowles Library $
Friends of Drakes Arts $
Bulldog Club $
Scholarship Support $
Donald Adams Leadership Institute $
College/School $
Specific Requests:

Is this gift a part of a Matching Gift?

Make sure to include additional information about your Matching gift in section #3.
Is this gift filling a previous Gift Pledge? If yes, please include the pledge number.

3. Matching gift information (if applicable):
Company Name
Company Address


If matching gift is from Spouse, please fill-in in addition infomation below
Spouse's Name First
Last
Spouse's Company Name
Spouse's Company Address
Is Spouse an Alum of Drake University?

4. Payment information:

Please Mail in your payment to this address. Make sure to put "Online Payment" in the memo line.

 Drake University
Office of Institutional Advancement
2507 University
Des Moines, IA 50311-4505


5. Send me additional information:
How to make a gift of stock
How to include Drake in my will or estate plans



6. Submit this form:
Last Modified: 09/30/2009 10:03:49 by content editor