Nortex Communications Pledge Card Preferred Donation Method Options - Select One Payroll Deduction Check Cash Credit Card Amount Per Pay Period Frequency you are Paid - None -Weekly (52 times/yr) Bi-Weekly (26 times/yr)Semi-Monthly (24 times/yr)Other If other, what frequency: Amount of Cash Amount of Check If donating by credit card, 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 - Select -Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code Email Address Office Phone Cell Phone Donor Notes Donor Notes CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
