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Pledge Form Avera

Invalid Submission Values

    This form is for Avera payroll deductions and "bill me" requests. If you prefer to donate via credit card, please click here.
    Step 1: Donor Information

    Example: janedoe@fakeemail.com

    Step 2: How Would You Like To Give?
    Please complete one of the two options below.
    (If you prefer to donate via credit card, please click here.)
    Option A: Payroll Deduction - begins January 1, 2022

    Example: 1,000.50

    Example: 1,000.50

    Option B: Bill Me - begins January 1, 2022

    Example: 1,000.50

    Billling Frequency
    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)
    Are you a CHAMP giver? (You are pledging to donate at least an hour of your pay, each month, to CAUW.) (required)
    Are you a LEADERSHIP Giver? (May be combined with your spouse.) (required)
    (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)