Donor Form
ANNUAL APPEAL 2000
Contribution Form
Yes! I want to contribute to the future of IIT Kharagpur!
Name: ________________________________________________________________________
Address: ________________________________________________________________________
City: ________________________ State: _____ Zip: __________
Phone: (H)_________________________________(W) _________________________________
Email: (H)_________________________________(W)__________________________________
School Information: Graduation Year: _______ Major: _________ Residence Hall: __________
Check enclosed for: $
[ Checks should be made payable to "IIT Foundation" ]
Credit Card Donation of: $
Name on Card: ___________________________________________
Credit card number: ______________________________________
Expiration Date: ______________ Card Type: Visa Mastercard
Signature for authorization: __________________________________
[ ] Please keep this donation anonymous
[ ] My company offers MATCHING FUNDS.
[ Please attach or send proper-signed form from company ]
Thank you for your support of the IIT Foundation and it's programs.
Your gift is tax-deductible. Federal Tax ID # 47-0747227
Please print this form, fill it out and mail it to:
IIT Foundation
P.O. Box 27824
Omaha, NE 68127-9821
or FAX it to:
(402) 537-7702
Attn: Jane O'Connor
