Do Good. Live United. | General Pledge Form

Invalid Submission Values

This form is for payroll deductions and "bill me" requests. If you prefer to donate via credit card, please click here.

If you are an Avera employee, please use this form.
If you are a Pierre School District employee, please use this form.

Step 1: Donor Information

First Name (required)

Last Name (required)

Business/Employer (required)

Employee ID/Number (if applicable)

Home Mailing Address (required)

City (required)

State (required)

Zip Code (required)

Email (required)

Example: janedoe@fakeemail.com

Phone Number (required)

Step 2: How Would You Like To Give?
Please complete one of the two options below.
(If you prefer to donate via credit card, click here.)

Option A: Payroll Deduction*

My pay period is

My total pledge amount for 2023 is

Example: 1,000.50

*NOTE: Please ensure your company allows payroll deductions, before selecting this option. Deductions start with the first January 2023 pay period. If your total pledge amount is not divisible equally between payroll cycles, we will round up to the nearest cent.

Option B: Bill Me

Enter the total amount you want to pledge in 2023*

Example: 1,000.50

Billling Frequency

Once for the Total

Quarterly

*NOTE: Your first invoice will be mailed in January 2023.

Step 3: Pledge Acknowledgment & Confirmation

Are you an Evergreen giver? By checking the box below, I acknowledge that I want my gift to renew automatically each year. (required)

Yes please automatically renew my gift annually.

No I would like to manually submit my gift annually.

Are you a CHAMP giver? (You are pledging to donate at least an hour of your pay, each month, to CAUW.) (required)

Yes

Are you a LEADERSHIP Giver? (May be combined with your spouse.) (required)

$500+

$1000+

No (less than $500 pledge)

For LEADERSHIP Giving, please combine my gift with my spouse. (List spouse and their employer.)

I would like my thank you to be sent via(required)

I wish my gift to remain anonymous.
(Please note: If you choose this option, you will not show up on any listings, even if you are a CHAMP or LEADERSHIP Giver.) (required)

Yes

Signature (required)

Do Good. Live United. | 2022-2023 Campaign Pledge Form