Brick/Paver Form

The Jefferson College Foundation is offering the opportunity to leave a legacy in brick while paving the way for future scholars!

This is an opportunity for alumni and friends to be acknowledged and become a part of the history that is Jefferson College. This exciting project will provide a lasting tribute to friends and family while helping to ensure the continued academic success of our aspiring students.

Bricks will be engraved on the Alumni and Friends Patio outside of the Student Center.

Brick/Paver Information

Selection

Please enter your text below. (Max 20 characters per line)

Paver Line 1

Paver Line 2

Paver Line 3

I would like to dedicate this donation

Contact Information

Title (Mr./Mrs./Dr./Ms./Mr. & Mrs.)

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Work Phone

Yes, Jefferson College Foundation has permission to send SMS texts to my cell number.

Help Us Cover Costs

Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.

Yes! I want $150.00 to go to Jefferson College Foundation and I will donate a total of $155.25.No. I will donate $150.00 and Jefferson College Foundation will cover the processing costs.

Payment Information

Payment Options

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Privacy Policy
We take precautions to protect your information. We collect credit card or bank account information, names, addresses, and other data related to your transaction when you make a payment through our site. We use this information to process your payment. Donors are automatically added to our distribution list.

Terms/Conditions
By submitting your payment, you authorize us to charge the account above for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your pledge.