Payne County Pledge Form

United Way of Payne County Campaign

Preferred Donation Method

Donation Options - Select One

Check

Cash

Bill Me

Bank Draft

Credit/Debit Card

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. 9th 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 or Paypal

Thank you for your support of the United Way.

To complete your donation, please click below:

Pay by Credit/Debit Card or Paypal

My Contact Information

Department

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.