1 Start 2 Complete Preferred Donation Method Options - Select One Payroll Deduction Check Cash Credit Card or ACH Amount Per Pay Period Frequency you are Paid - None -Weekly (52 times/yr)Bi-Weekly (26 times/yr)Semi-Monthly (24 times/yr)Other Please indicate how often you are paid: If other, what frequency: Amount of Check Amount of Cash If donating by credit card or ACH, please CLICK HERE to exit this form and complete your online transaction. Employer Employer Name * Location/Department Name Employee Number My Contact Information First Name * Last Name * Home Address * City * State * AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Email Address * Office Phone * Cell Phone Donor Notes Donor Notes
