Frontier Electronic Systems Pledge Form

Payroll Deduction

Frontier Electronic Systems will collect payroll deductions from each of your 26 pay periods beginning January through December.

Check below to give your employer permission to deduct your gift from your payroll.

I give permission.

Contribution Amount Per Pay Period

$2

$5

$10

$25

$50

Other Amount

TOTAL PLEDGE AMOUNT: $0

Check

Cash

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.

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.

Start Date (bank drafts begin on January 5 by default)

Special instructions

TOTAL BANK DRAFT AMOUNT: $0

Credit/Debit Card or Paypal

My Contact Information

First Name

Last Name

Home Address

City

State

Zip Code

Email Address

Phone Number

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

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

Donor Notes & Financial Authorization

Donor Notes

I authorize the financial transactions and terms above.

Yes, I agree and authorize.

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

United Way of Payne County Campaign

Thank you for your support of the United Way.

To complete your donation, please click below:

Pay by Credit/Debit Card or Paypal

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