Retiree Online Pledge Form

SECC Retiree Pledge Form

I would like to keep my gift anonymous to charities

Check this box if you do not want any designated charities to receive your name or address from the SECC when sending donation information

Keep my Gift Anonymous

Name(Required)

First Last

Department/University Retired From(Required)

Enter the General Govt Department or University that you work in

Division/Academic Unit(Required)

Please enter the sub division, sub department, etc. that you work in

Home Address

***ONLY PROVIDE THIS INFORMATION IF YOU WISH TO RECEIVE A GIFT ACKNOWLEDGMENT BY MAIL***

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Daytime Phone

Email(Required)

Enter Email Confirm Email

Pledge and Payment Options

Please Choose a Payment Option for your Pledge(Required)

Check (Payable to NC SECC, mailed to PO Box 196, Durham NC 27702)

Credit Card

Stock Transfer/Matching Gift (Contact SECC office to provide details)

Total Pledge(Required)

Enter the TOTAL amount you wish to pledge

Gift Designations

Approved Charities are listed in the 2023 SECC Giving Guide and can also be found using the charity search at ncsecc.org. Pledge money left undesignated or designated to a charity not listed will be deemed undesignated funds. Undesignated funds are proportionally distributed to charities receiving designated gifts. A minimum of $10 per year and per charity is required to designate.

Would you like your pledge to be undesignated?(Required)

If you want the total amount of your pledge to be "undesignated" Please click "yes" below. If you want your donation split amongst 1 or more charities then please click "no"

Yes

Charity Designation Choices(Required)

Please use the table below to enter the information for all charities you wish to designate part of your donation to (**To add additional designations, click the + on the far right of the top row of designations**). Please be sure to include information for all fields. (IF KEEPING YOUR GIFT UNDESIGNATED, PLEASE INPUT "0" FOR EACH FIELD

SECC Code

Charity Name

$ Amount to Designate

Disclosure

Your SECC contribution is tax-deductible to the extent allowed by law. For tax purposes, nothing of substantial value was given in return for this contribution. Retain a copy of your pledge form and either your canceled check, credit card statement, or year-end payroll deposit slip as proof of your contribution. Call the NC SECC office at 919-821-2886 for more information, if needed. THE FEDERAL TAX ID (EIN) FOR THE NC SECC IS 56-1775025

Total

Credit Card Pledge Payment

American Express

MasterCard

Visa

Card Number 123456789 Expiration Date mm/yy Security Code Cardholder Name