Pulaski Tech Home
For further information or questions regarding your gift or pledge, please call (501) 812-2778.

Your can also make a gift or pledge by sending a check payable to:

PTC Foundation
3000 West Scenic Drive
North Little Rock, AR 72118
Faculty & Staff Campaign

   

Click here to download a printable PDF form.


* required fields

* Title:
* First name: * Last name:
* I am Full-Time Staff   Part-Time Staff
Full-Time Faculty   Adjunct Faculty
* Division
* Home Address:
* City: * State:   * Zip:
* Country:
* Telephone (with area code):
Fax (with area code):
* E-mail address:
Other e-mail address:


* How would you like to be recognized?

Please recognize my gift as:
(Put exactly how you would like your name to appear on all donor recognitions.)

I prefer to keep my gift anonymous.


If your credit card billing address is different than the one above, please enter it here:
Address:
City: State:  Zip:
Country:

I wish to contribute through a single credit/debit card deduction
* required if making a single credit/debit card deduction

* Please deduct $ from my credit/debit card.
I wish to contribute through payroll deduction
* required if making a payroll deduction

* Please deduct $ per paycheck.
* Beginning July 1, 2014 for one full year (26 paychecks)
* Beginning July 1, 2014 until further notice
I wish to contribute by a credit/debit card pledge
* required if making a pledge by credit/debit card

 * Amount: * Number of payments: 
* To be paid in installments of:
* Payment frequency:
* Payments to start at: -- (mm-dd-yyyy)


Please inquire with my spouse's employer about the opportunity to match my gift.
Company name: