Preferred Donation Method Options - Select One * Payroll Deduction Check Cash BIll Me Bank Draft Credit Card or Paypal Company Name * HR/Payroll Contact Name HR/Payroll Phone Number HR/Payroll Email Total Pledge * Amount to be deducted per pay period * My pay period is: * - Select -Weekly (52 times/yr)Bi-Weekly (26 times/yr)Semi-Monthly (24 times/yr)Monthly(12 times/yr)Other If other, what frequency: * Start Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202120222023 Amount of Check * Please 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. Amount of Cash * Please bring cash to our office at 109 E. Ninth Ave. Stillwater, OK 74074. Total Gift Amount * Frequency of Donation * One time Quarterly Monthly Other If other, what frequency: * Start Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202120222023 Special instructions for invoicing Bank Name * City * State * Zip * Routing Number * Account Number * Total Gift Amount * Amount per draft * Frequency of Donation * One time Quarterly Monthly Other If other, what frequency: * Checking or Savings * Checking Savings Start Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202120222023 My Contact Information First Name * Last Name * Home Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Email Address * Phone Number Employer or Organization Department Donation Details Make my gift perpetual (Notify our office to stop or adjust payments.) Yes No Make my gift anonymous Yes No Would you like to combine your pledge with your spouse/partner's donation? Yes No Spouse's/Partner's First & Last Name * Spouse's/Partner's Employer * Designation - None -4 Kids and CommunityAmerican Red CrossBig Brothers Big SistersCASA for KidsGirl Scouts of Eastern OklahomaLegal Aid Services of OklahomaLife Adult Dav CenterMPowerMission of Hope Homeless ShelterPayne County Drug CourtPayne County Youth ServicesStillwater CaresStillwater InterfaithStillwater Community Health CenterStillwater Group HomesStillwater Literacy CouncilStillwater Mobile MealsThe Salvation ArmyThe Saville CenterWings of HopeYMCA of Stillwater Donor Notes Donor Notes I authorize the financial transactions and terms above. * I Agree I authorize the financial transactions and terms above. * I Agree I authorize the financial transactions and terms above. * I Agree I authorize the financial transactions and terms above. * I Agree I authorize the financial transactions and terms above. * I Agree Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
