Current Start Review Your Pledge Complete Preferred Donation Method Donation Options - Select One Credit/Debit Card Payroll Deduction Check Cash Bill Me Bank Draft Payroll Deduction Company Name HR/Payroll Contact Name HR/Payroll Phone Number HR/Payroll Email Check below to give your company permission to deduct your gift from your payroll. I give permission. My pay period is: Weekly (52 times/year) Bi-weekly (26 times/year) Semi-monthly (24 times/year) Monthly (12 times/year) If other, what frequency? Enter other… Contribution Amount Per Pay Period $5 $10 $25 $50 Other Amount Enter Other Amount TOTAL PLEDGE AMOUNT: 0 Start Date (payroll deductions typically begin Jan.1): Check TOTAL CHECK AMOUNT: 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. Cash TOTAL CASH AMOUNT: Please 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 - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 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 support of the United Way. To complete your donation, please click below: Pay by Credit/Debit Card My Contact Information First Name Last Name Mailing Address City State - Select -Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code Email Address Phone Number Donation Details Is this donation for the Stillwater Strong Relief efforts? Yes No Company or Business Employer or Organization Department Employee ID# Make my gift anonymous. Yes No Additional Details Make my gift perpetual. (Notify our office to stop or adjust payments) 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 Would you like to designate your gift to one or more partner agencies? If no, your gift will be equally distributed amongst all agencies. Yes No Partner Agency Designation (if you select multiple, your gift will be equally distributed): 4 Kids and Community American Red Cross of Northern OK Big Brothers Big Sisters of Stillwater CASA for Kids Dolly Parton's Imagination Library Early Childhood Coalition Girl Scouts of Eastern Oklahoma Legal Aid Services of Oklahoma Life Adult Day Center MPower Mission of Hope Homeless Shelter Mobile Meals of Stillwater Payne County Drug Court Payne County Youth Services Stillwater CARES Stillwater Community Health Center Stillwater Group Homes Stillwater Habitat for Humanity Stillwater Interfaith Counseling Center Stillwater Literacy Council The Salvation Army of Stillwater The Saville Center for Child Advocacy Wings of Hope Family Crisis Services YMCA of Stillwater Stillwater Strong Relief Donor Notes & Financial Authorization Donor Notes I authorize the financial transactions and terms above. Yes, I agree and authorize. Leave this field blank
