The Ann Wayson Locher Memorial Fund for HIV Care


Thank you for making a commitment to The Ann Wayson Locher Memorial Fund for HIV Care at The University of Toledo. Your support is greatly appreciated!
Please complete the following pages so that we may receive and acknowledge your contribution as quickly and easily as possible. We appreciate your commitment to support The University of Toledo. In return, the UT Foundation assures you that all sensitive data and personal information involved in the online gift process is handled through our secure server.
If you are an employee of The University of Toledo or UT Medical Center, please go here for payroll deduction and other giving options. https://give2ut.utoledo.edu/FacultyStaff.asp

Tell us who you are:
Title:
First Name:
Last Name:
Suffix:
Former Name:
Preferred Class Year:
Address:

City:
State:
Postal Code:
Country
Home Phone:
Cell Phone:
Email:
Spouse/Partner Name:
Spouse/Partner Class Year:

Choose the area(s) your contribution will support:
Please enter the code from the mailing or email you received (e.g. AG2013 ABC123 PML)
The Ann Wayson Locher Memorial Fund for HIV Care	$
Other designation not listed above: Click here for a list of available funds	$
Total: (will automatically be calculated when you tab here)	$
Special instructions for this gift:

How will you make this contribution?

A) I am paying by credit card. (Your credit card will be processed immediately upon submitting the page.)

B) I will mail a check or money order for the entire gift made payable to:

The University of Toledo Foundation
PO Box 586
Toledo, OH 43697-0586

(On the memo line, please indicate the area of support or fund name. Include a copy of your confirmation page with the check or money order.)

C) I am making a pledge. I will begin my payments at a later date. (Fill in the pledge details below.)

Charge my credit card for each installment as it comes due.
Bill me for each installment as it comes due.
I will mail a check now for my first installment. (Reminders for future installments will be sent to you as they come due.)

D) I am making a pledge. Charge my credit card for my first payment now. (Fill in the pledge details below. Your credit card will be charged for the first installment immediately upon submitting this page.)

Charge my credit card for all my future installments. (If this is NOT checked, reminders for future installments will be sent to you as they come due.)

If you are making a pledge (by choosing option C or D above), please give us the details of your pledge:
The total amount of my pledge is : I agree to pay $ every beginning Note: Payroll deduction frequency options are available for UT employees only.The minimum payroll deduction amount is $5.00 per pay.

Enter your credit card information:
Please enter the funds in US dollars. We cannot guarantee that letters such as these (é, ú, â, ô, ñ, ö, ç,) will be processed correctly through the credit card processor. When typing, please do not use characters such as these. If you need assistance, please call our office at 419.530.7730.
Credit Card Type	Online Payments
Card Number C V V What is this?
Expiration Date /

Billing information Same as above Not Same
Billing First Name
Billing Last Name
Billing Address
Billing City
Billing State/Province
Billing Postal Code
Billing Country

Do you or your spouse work for a company that will match your gift?
Many employers sponsor matching gift programs that can double or triple your contribution to UT. If you are unsure if your company is a matching gift company or have questions about matching gift ratio, eligibility or procedure, click here. Please note, your company's match counts toward your gift recognition level.
	I will obtain a matching gift form from my employer and send it to the UT Foundation at 2801 W Bancroft St MS 319, Toledo, OH 43606
	Company Name	Company Address
If this gift will be matched by spouse's employer please indicate below:
	Spouse's Company Name	Spouse's Company Address

Submit this form

(Please do not submit the same page more than once.
Doing so could result in multiple charges to a credit card.)

For questions about this webpage, please call our office at 419.530.7730 or email us at utfoundation@utoledo.edu