Jerry Ellis Scholarship Fund - Pledge Form

Instructions: You may donate a gift in support of the "Jerry Ellis Scholarship Fund" online at:

www.umainefoundation.org/ssl_secure

Or you may print, complete this page, and send it to:

University of Maine Foundation
Two Alumni Place
Orono, Maine 04469-5792

Yes, I would like to contribute to the Jerry Ellis Scholarship Fund. My check made payable to the University of Maine Foundation in the amount of $________ is enclosed. Or you may charge $________ to my credit card below:

First Name:_______________________________________________

Last Name:_______________________________________________

City: ____________________ State: ______ Zipcode:____________

Telephone:___________________________

Name on Credit Card:_______________________________________

Credit Card No:____________________________________________

Expiration Date:_______________________________

Signature:________________________________________________

 

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