1 Start 2 Complete Preferred Donation Method Options - Select One - None -Payroll DeductionCheckCashCredit Card or ACH Amount Per Pay Period Fair Share (ONE HOUR'S PAY PER MONTH) 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: FairShare? (1 Hour Pay/Month) Yes No 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 - None -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 Select Designation - None -General FundBlue Ridge Community Center Renovation Fund Donor Notes CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions.
