Preferred Donation Method Options - Select One Payroll Deduction Check Cash BIll Me Bank Draft Credit Card or Paypal Payroll Deduction 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 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. Bill Me Total Gift Amount $ Frequency of Donation One time Quarterly Monthly Other If other, what frequency: Start Date Special instructions for invoicing Bank Draft 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 Click Here to Pay by Credit Card or Paypal My Contact Information First Name Last Name Home 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 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 Day CenterMPowerMission of Hope Homeless ShelterPayne County Drug CourtPayne County Youth ServicesStillwater CaresStillwater Community Health CenterStillwater Group HomesStillwater Habitat for HumanityStillwater InterfaithStillwater Literacy CouncilStillwater Mobile MealsThe Salvation ArmyThe Saville CenterWings of HopeYMCA of Stillwater Donor Notes Donor Notes I authorize the financial transactions and terms above. - Select -I Agree I authorize the financial transactions and terms above. - Select -I Agree I authorize the financial transactions and terms above. - Select -I Agree I authorize the financial transactions and terms above. - Select -I Agree I authorize the financial transactions and terms above. - Select -I Agree Submit Leave this field blank
