Washburn Law Annual Fund Donation Form

Print and complete this form and mail with your check or credit card information to:

Washburn University School of Law
Advancement Office
1700 SW College Ave.
Topeka, KS 66621-1140

Name:     ___________________________________________

Class of: _________

Firm/
Business: ___________________________________________

Address:  ___________________________________________  Home/Work
          Street

          ______________________________________________
          City               State                 Zip

Phone:    ______________________________________________
          Home                       Work

E-mail:   ____________________________________________  Home/Work

___ I have remembered the School of Law in my estate plan
___ Please contact me regarding planned giving opportunities
___ Please also credit my spouse, ___________________ Class of ______
___ I do not wish to be listed in the donor honor roll

Gifts to the current Annual Giving Campaign must be received
no later than June 30.

I would like to make my gift in the form of:

___ Charge $_______________ to Visa / MasterCard / Discover / Am Ex

Account No: _______________________________  Expiration ______________

Signature: ___________________________________________

___ Check $_______________
(Please make checks payable to Washburn Law School Foundation)

___ Pledge $_______________
(unless you request otherwise, we will send quarterly reminders of
your pledge balance)

___ Matching Gift $_______________ from your company or firm:

    ______________________________________________

___ Washburn University Foundation Monthly Payment Plan
    Authorization

1. I am happy to support Washburn University with a monthly
contribution conveniently paid through my bank.  I authorize
my bank to pay to Washburn University Foundation the amount
below, according to the terms of agreement below, by signing
the form below.

2. Attach your check for the first monthly pledge.  The automatic
withdrawal will begin with the second month's payment.  Your check
allows us to record the bank account and bank routing numbers correctly.

3. Withdraw my contribution on the ___ 10th or ___ 25th day of the month.


  Monthly Pledge: ______________

  Signature: ___________________________________________

  Date Signed: ______________________________

  My monthly gift amount of $__________ beginning on ____________

TOTAL CONTRIBUTION $_______________

Monthly Payment Plan Authorization Terms of Agreement

The authorization to charge Contributor's account at Bank shall be the
same as if Contributor had personally signed a check to Washburn
University Foundation.  This authority is to remain in full force and
effect until Bank has received written notification from Contributor of
its termination and Bank has had reasonable opportunity to act on it,
or until Bank has sent Contributor ten (10) days written notice of
Bank's termination of this agreement.

A record of charge will be included in Contributor's bank statement.
This record will serve as Contributor's receipt.

In the event of an error, Contributor has the right to authorize Bank
to reverse any charge.  This must be done by written notice within
fifteen (15) days of the date of the bank statement or within
forty-five (45) days after the charge was made.

It is understood and agreed that Bank shall have no responsibility
for the correctness of any charge herein contemplated and that any
dispute involving the amount thereof shall be handled by the
Contributor with Washburn University Foundation.

Washburn University Foundation is authorized to adjust the monthly
pledge amount as necessary to reflect the current pledge agreement
at that time.