DONOR DETAILS *Mandatory Field
* Title:
* First Name:
* Family Name:
Post Nominals:
* Postal address:
* Business Name:
*ABN:
* Business Address :
* Email:
Mobile:
* Telephone (business hours):
* Website:
INFORMATION, INVITATIONS AND NEWSLETTERS
In the normal course of our business we regularly send out correspondence including invitations and newsletters. We would like to be able to
send these out electronically to your email address where appropriate. Would you prefer to receive your correspondence by email or by hard
copy through the post? Please tick the appropriate box.
 Email
 Hard copy
GIFT DETAILS
I would like my gift to support:
 Scholarships
 Student Prizes
of
 Redevelopment
University Theatre
 $120
 $200
 $300
 $500
 Emerging Needs (untied)
I would like to donate:
 $50
 $75
 $1000
amount
 Other
(please specify) $
 I am interested in finding out more about bequests to the University
As a:
 Single gift
PRIVACY
 Gift every month
 Gift every 3 months
 Gift every 6 months
 Gift every year
 Please tick if you do not wish to have your name published in a list of donors.
Your privacy is important to us and we are committed to protecting it. The University’s Privacy Statement can be found at
www.cdu.edu.au/governance/doclibrary/pol-32.pdf
PAYMENT OPTIONS
Cheque/Money order as attached (made payable to: Charles Darwin University Foundation)
 Visa
 MasterCard
 Diners
Card No:    

Direct Deposit
Account: 301036
Credit Card
Cardholder name: .........................................................
Bank: Westpac, Darwin NT
Amex
Amount: $ ..................... Expiry date: ........................
Cardholder signature: ..................................................................
BSB: 035-302
Transaction description: Payee name and short description of payment type
Gifts to the Foundation are allowable deductions for income tax purposes. A receipt will be sent to your postal address.
Please complete, scan and forward this from to [email protected] with a note of date of the EFT payment of this applies, or mail
this form, along with your cheque, to Charles Darwin University Foundation, Mail Room, Reply PAID 40146, Charles Darwin University,
Darwin NT 0909, Australia
T. 08 8946 6619 | F. 08 8946 6533 | E. [email protected] | W. www.cdu.edu.au/foundation