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I want to help get scholarship football back at APSU!!!

Yes! I want to join APSU alumni and friends by participating in helping to bring scholarship football back to the university.

*If your computer doesn't open Adobe PDF files, then please use the following form to make a pledge/gift, credit card, or an "electronic fund transfer" contribution.

If your browser doesn't support forms, please send e-mail to advancement@apsu.edu and we will mail you a pledge form.

All gifts should be mailed to:   University Advancement
                                             Austin Peay State University
   P. O. Box 4417
       Clarksville, TN 37044

Your gift is tax deductible, as allowed by law.

First Name:
Middle Name:
Maiden Name:
Last Name:
Previous Name:	Are you known to Austin Peay by any other name?
Address Line 1:
Line 2:
City:
State:	Zip Code:
Phone:	(Please include area code)
E-Mail:

My gift of has been mailed to the above address.

Please debit my/our bank account per month through the APSU Electronic Funds Charitable Contributions Program. Complete and return the Authorization form along with a voided check.

Please charge my gift/payment automatically to my credit card (VISA/MC). Complete and mail the credit card form.

I prefer to complete this gift by making payments of in the months : (indicate by checking). Please send pledge reminders during the months indicated above.

Sept	Dec	Mar	June
Oct	Jan	April	July
Nov	Feb	May	August

Please direct my gift to:
Scholarship Football

My or my spouse's company will match this contribution for a total gift of Matching Gift Program: You can double or triple the size of your gift if you are employed by one of the more than 1,000 companies with matching gift programs. These companies often match the charitable gifts of their retirees and, in some cases, gifts made by an employee's spouse. Your personnel office will supply you with the appropriate form which should be returned with your gift. The University cannot initiate this action.

Credit Card Form
For your protection, we are unable to accept credit card donations via the Internet. Please fill out, print and mail this form and we will be pleased to process your gift.
Card No.:____________________________________
Expiration Date:________

VISA MC
Gift Amount:__________ Signature:_______________________________ Name:___________________________Grad Yr______ (Print) Address:__________________________________ City:_____________________________________

Mail to: Austin Peay State University
           Scholarship Football
            P. O. Box 4417
            Clarksville, TN 37044

APSU Electronic Funds Transfer Charitable Contribution Form
Please fill out, print and mail this form and we will be pleased to process your gift.
Please debit my/our bank account $_______________ per month through the APSU Electronic Funds Transfer Charitable Contributions Program. I have enclosed a voided check for this account and signed on the signature line below to authorize these withdrawals. NOTE: The first draft will occur approximately 30-45 days after receipt of your authorization and thereafter on or about the 10th of each month until written notification is received requesting its termination. Signature:_________________________________ Date:__________________ Mail to: University Advancement Austin Peay State University P. O. Box 4417 Clarksville, TN 37044

University Advancement
Austin Peay State University
Browning Building, Room 216
P. O. Box 4417
Clarksville TN 37044

Telephone: (931) 221-7127
Fax: (931) 221-6289

For questions or comments, please email wirtsm@apsu.edu