Donation Request Form

  1. Step 1 Entry
  2. Step 2 Confirmation
  3. Step 3 Completion

Donation Information

Donation Purpose
Donation Purpose (please specify)
Donation Purpose(please specify)

Education Support Projects

Donation Purpose(Other)
Donation Method and Amount

Please select.

  • (JPY)
  • (JPY)
  • (JPY)
  • (JPY)

Personal Information

Application Category
Name
Last Name    
First Name
Organization name    
Business Title of Representative    
Name of representative    
Division of Contact Person
Name of contact person    
Date of Birth      
Address
Address1
Address2
City/ State/ ZIP
Telephone number
E-mail Address
E-mail Address (confirmation)
E-newsletter
   
Your relationship with Gifu University

Listing of Donors' Name

We may post your name and the amount of donation on our website. Please place a check mark in the box below to indicate your agreement/disagreement with the posting.




Display of Nameplate

We may display your nameplate as a donor (who have donated an accumulated total of 100,000 yen or more for an individual, and an accumulated total of 500,000 yen or more for a cooperation/organization)



Message to
Gifu University
You can write a brief comment on our website.
Please enter any comments or questions (within 140 characters)

Number of characters: characters

Advice and Proposal
Please enter any comments or questions (within 1,000 characters).
Number of characters: characters

Payment Information

  • Payment by Credit Card

Payment can be made with any credit card displaying one of the following marks.

visa master mufg dc ufj nicos jcb amex diners


Credit Card number

  • e.g.) 012345678999999

Card Expiry Date

/   e.g.) 01/25

*Enter only the last two digits of the year.

*Please be sure to input the month then the year.

Card Verification Code

e.g.) 123

In order to prevent unauthorized use of your credit card, please follow the example below.

security_eng_1 security_eng_2 security_eng_3

How to Make A Donation by Credit CardHow to Make A Donation by Credit Card

New Account


  • Please use this option if you would like your information to be saved for the next time you apply.


Please read the Notices before submitting this form.