City of Cushing Pledge Form

United Way of Payne County Campaign

Step 1

Preferred Donation Method

Donation Options - Select One

Payroll Deduction

Check

Cash

Bill Me

Bank Draft

Credit/Debit Card

Payroll Deduction

City of Cushing will collect payroll deductions from each of your 24 pay periods beginning January through December.

Check below to give your employer permission to deduct your gift from your payroll.

I give permission.

Contribution Amount Per Pay Period

$10

$25

$50

Other Amount

TOTAL PLEDGE AMOUNT: $0

Check

TOTAL CHECK AMOUNT:

Please give checks to your campaign coordinator, or mail check to United Way of Payne County, P.O. Box 308, Stillwater, OK 74076 or bring check to our office at 109 E. Ninth Ave. Stillwater, OK 74074.

Cash

TOTAL CASH AMOUNT:

Please give cash to your campaign coordinator, or bring cash to our office at 109 E. Ninth Ave. Stillwater, OK 74074.

Bill Me

Frequency of Bill Me Donation

One-time

Quarterly

Monthly

Other

If other, what frequency? Please enter the number of times you wish to be billed in a year.

One-time Amount

Amount per Month

Amount per Quarter

Amount per Billing

Start Date

Special instructions for invoicing

TOTAL BILL ME AMOUNT $0

Bank Draft

Bank Name

City

State

Zip Code

Routing Number

Account Number

Frequency of Bank Draft Donation

One-time

Quarterly

Monthly

Other

If other, what frequency? Please enter the number of times you wish to be billed in a year.

One-time Amount

Amount Per Month

Amount per Quarter

Amount per Period

Start Date (bank drafts begin on January 5 by default)

Special instructions

TOTAL BANK DRAFT AMOUNT: $0

Credit/Debit Card

Thank you for your supporting United Way of Payne County.

To complete your donation, please click below:

Pay by Credit/Debit Card

Step 2

My Contact Information

First Name

Last Name

Home Address

City

State

Zip Code

Email Address

Phone Number

Donor Notes & Financial Authorization

Donor Notes

I authorize the financial transactions and terms above.

Yes, I agree and authorize.