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Provide donor details, fund and amount selections, joint gift and spousal/partner information, and payment method fields for checks and major credit cards. Support one-time or scheduled payments with automatic deduction instructions, signature and date lines, additional giving options (matching gifts, estate plans, securities), privacy notice language, and consent for use of personal information.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/sample-gift-and-membership-solicitation-remittance-templates-basic-gift-remittance-card-membership-remittance-card/384533/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/sample-gift-and-membership-solicitation-remittance-templates-basic-gift-remittance-card-membership-remittance-card/384533.png","ImageObject",442,249,{"name":88,"@type":89},"OmBimo","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-10","2026-09-24",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information is requested on the Basic Gift Remittance Card?","Question",{"text":109,"@type":110},"The form collects donor and recipient details, the fund name, selected gift amount, payment method details (check or credit card), optional joint gift information, and signature/date fields.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How can donors set up payments over time?",{"text":114,"@type":110},"Donors can choose one-time payment or a scheduled plan (e.g., included, semiannual, monthly, or quarterly). 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Spouse/Partner name:   Method of Payment: I prefer to pay by:  \n􀂉 Check: Please make check payable to The UCLA Foundation.  \n􀂉 Credit Card: 􀂉VISA 􀂉 MasterCard 􀂉 American Express 􀂉 Discover  \nCredit card \\#:   Expiration (mm/yy):   Name on card (please print):    \nAmount to be charged now: $   \nIf you would like to make your gift over time, please check one from each of the following categories:  \nFirst payment: (select one) Payment Schedule: (select one)  \n􀂉 Included 􀂉 One-time payment on  \n􀂉 To be made:   (month/year):    \n(month/year) 􀂉 2 semiannual payments  \n􀂉 4 consecutive monthly payments  \n􀂉 4 quarterly payments  \nFor my convenience, please automatically deduct my pledge payments on the 15th of the month(s) in accordance with the payment schedule selected above from my:  \n􀂉 Credit card (as completed above)  \n􀂉 Checking account (please include your first payment or attach a voided check showing name, address and account number to be charged)  \nSignature:   Date:    \nAdditional ways to give:  \n􀂉 Matching Gift: In addition to my personal gift, I have enclosed a matching gift form.  \n􀂉 Estate Plan: Please send me information on how I can include UCLA in my estate plan. Online: To give online, [visit ](visit www.campaign.ucla.edu)[www.campaign.ucla.edu](visit www.campaign.ucla.edu).  \nSecurities: Please contact the securities coordinator at (310) 794-3434 for detailed transfer instructions.  \n􀂉 Please update my contact information (make changes on reverse) .  \n(Advance ID)  \nJosephine Bruin ’76 (Phone Number)  \n1234 Westwood Blvd. (E-mail address)  \nLos Angeles, CA 90024  \nPlease send payment and this completed form in the enclosed envelope to: The UCLA Foundation, Box 7145, Pasadena, CA 91109-7145 (Do Not Send Cash) . For more information, please call: (Solicitation Initiator) at (Initiator’s Phone number) .  \nThank you for your tax-deductible gift in support of (Name of School, Dept. , Center)  \nI. D.\\# 0001234567 \\#1234 AC101  \nBack of Basic Gift Remittance Card  \nPlease help us update your information:  \nName: __________________________Preferred Address Position/Title: _______________________  \nCompany Name:    \nAddress:  􀂉 Home 􀂉 Business Company Address:    \nPreferred E-mail  \n_______________________________ __________________________________  \nHome Phone:   ~~ ~~ Business Phone:    \nHome E-mail:  􀂉 Home 􀂉 Business Business E-mail:   Date of Birth:  / /  Marital Status:    \nPlease help us update your spouse/partner’s information: Is spouse/partner a UCLA alumnus? 􀂉 Yes 􀂉 No  \nName of spouse/partner:   Name at graduation:   Class year:    \nPrivacy Notice: The 1977 California Information Practices Act requires UCLA to inform individuals asked to supply information about themselves of the following: UCLA is requesting this information to update the general resource files of its External Affairs Department. Furnishing the information is strictly voluntary and will be maintained confidentially. The information may be used by other University departments in the regular course of business but will not be disseminated to others except if required by law. You have the right to review your own data file. Inquiries should be forwarded to Assistant Vice Chancellor-Finance and Information Management, External Affairs, 10920 Wilshire Blvd. 9th Floor, Los Angeles, CA 90024-6511. Donor's Consent to Use Personal Information: The University is grateful for the support it receives from alumni, parents, and friends. One of the ways we express our thanks is by listing the names of donors in Web-based and/or print publications. Should you wish that your name not appear as a donor, please notify us if you have not alread","cbCaioo3pQ6gqEHU","https://ap.wps.com/l/cbCaioo3pQ6gqEHU","pdf",126475,"English","# Basic Gift Remittance Card\n## Payment options and schedules\n## Additional ways to give and authorization\n# Basic Membership Remittance Card\n## Membership options and payment method\n## Authorization signature and date\n# Privacy Notice and Consent","[{\"question\":\"What information is requested on the Basic Gift Remittance Card?\",\"answer\":\"The form collects donor and recipient details, the fund name, selected gift amount, payment method details (check or credit card), optional joint gift information, and signature/date fields.\"},{\"question\":\"How can donors set up payments over time?\",\"answer\":\"Donors can choose one-time payment or a scheduled plan (e.g., included, semiannual, monthly, or quarterly). The form also authorizes automatic deduction on the 15th from a credit card or checking account.\"},{\"question\":\"What privacy and consent terms are included?\",\"answer\":\"The privacy notice explains voluntary data sharing for updating university resource files, confidentiality handling, donor data review rights, and related inquiries. It also includes donor consent for listing names in web-based and/or print publications unless the donor requests otherwise.\"}]","Sample Gift and Membership Solicitation Remittance Templates - Basic Gift Remittance Card - Membership Remittance Card | PDF",1790263934]