The H. Stanley Hanson Scholarship Contribution Form

Contribution Form
Please print and sent completed form to address below.

The H. Stanley Hanson Geology Scholarship

Please accept my gift of $ _____________________________.

Name: ____________________________________________

Address:

__________________________________________________

__________________________________________________

__________________________________________________

SS#: ______________________________________________

Date: ______/______/________

Method of payment:

Cash Check Credit Card* Pledge*
*Please complete appropriate information below.

Credit Card information: VISA Mastercard
Account # _____________________________

Expiration Date _____________________________

Signature _____________________________

Preferred pledge payment schedule:

Please bill me for the total in 30 days
Please bill me quarterly in Dec., Mar., June, Sept.
Please bill me in equal payments for the following months:
__________________________________________________

__________________________________________________
Other
__________________________________________________

__________________________________________________


PLEASE MAKE CHECKS PAYABLE TO:
THE GEORGIA SOUTHERN UNIVERSITY FOUNDATION

PLEASE MAIL CHECK AND CONTRIBUION FORM TO:
P.O. Box 8053, Statesboro, GA 30460-8053


Georgia Southern University's fiscal year ends June 30. All gifts are tax deductible as the law allows.

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