University of Prince Edward Island, UPEI, Charlottetown, PE, Canada







Printable Pledge Form

INSPIRE! Campaign

Alumni and Friends website








Please note: This is a secure site. Read more about UPEI's Personal Information and Privacy Policy. Upon completion and submission of this form, a charitable tax receipt will be sent to you by mail unless you have selected the "I do not require a charitable tax receipt" box.




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Make Your Gift











*Gift Amount


I do not require a charitable tax receipt.








*Gift Type









If you have indicated that your gift represents a Monthly, Quarterly, of Annual Installment, please complete the fields below:








Start Date:

15th of

Number of Installments:



eg: If you selected monthly payments, they will be processed on / around the 15th of the month indicated above, for the number of months indicated in the box to the left.





Designate your Gift









I would like to make a gift to:

 Click on the down arrow for more options.



Please specify:





Honour / Memorial (if applicable)









This gift is in honour of;  in memory of:  












We would be happy to notify the family of your kind gesture. If you wish for us to do so, please provide the name and address below. The amount of your gift will not be disclosed.








Personal Information










 Dr      Miss      Mr      Mrs      Ms



*Last Name



*First Name



Middle Name / Initial









Home Address Information



*Street Address



Apartment / Unit #



*City / Town



*Province / State






*Postal / Zip Code



*Phone Number
(Please include area code)

 -  -












Spouse’s/Partner’s Information




Last name



First name



Middle name





Credit Card Information









*Choose one:











American Express




*Card Number



Please enter your credit card number without any spaces or additional characters (hyphens, slashes, etc.)



*CVV Number



CVV for Visa and MasterCard is the final three digits of the number printed on the signature strip on the back of your card. CVV for American Express appears as a separate 4-digit code printed on the front of your card.



*Expiry Date




*Name as it appears on the card:





Recognition of Your Gift









Please indicate how you would like your name(s) to appear in any donor listings that may apply to your gift:








 This gift is anonymous.





Additional Information









I would like to find out more about making a gift to UPEI through my estate: bequests, gifts of life insurance, or other planned gifts. Please send me further information.  Yes     No









Additional comments:











*Are you a PWC/SDU/UPEI Alumnus?  Yes     No



Is your spouse/partner a PWC/SDU/UPEI Alumnus?   Yes     No     n/a









(This button will cancel your gift without submitting any information.)
















Thank you -- unless you have indicated otherwise -- a charitable tax receipt will be sent to you by mail.









Development & Alumni Engagement, Steel Building, 550 University Avenue, Charlottetown, PE Canada C1A 4P3

telephone (902) 894-2888 or toll free 1-866-453-4119
fax (902) 566-0782

Charitable Reg. #
10816 2108 RR0001

Copyright 2012 | © University of Prince Edward Island