Pledge Form (2)

Employee Information

Address

Step 1: Choose the program(s) you want to support

STEP 2: Tell us how much and how many installments

Your donation amount will be split evenly amongst all the programs you select to support.

A. Ongoing deduction (Recurring pay periods)

Recurring Donation per pay period
Recurring Pay Periods

B. 1-year commitment

Donation per pay period x 26 pay periods
26 Pay Periods

C. One-time deduction

Donation per pay period x 1 pay period
1 Pay Period

TOTAL DONATION AMOUNT

If you selected option A, recurring payments, the total amount is the dollar amount per pay period that will be deducted and does not reflect the total donation you will make.

Acknowledgement