Hargrove Foundation Pledge Form

Personal Information
Name *
Work or Cell Number
Work or Cell Number
Home Address
Home Address
Payroll Deduction Authorization Information
Please choose if you would like to make a one time donation or a recurring payroll deduction.
Please enter the amount you would like to donate.
Payroll Deduction Terms and Conditions *
This authorization remains in full force until written notice is received to modify or cancel. This payroll deduction is not a pre-tax deduction, and therefore, does not affect the amount of taxes owed and withheld from my paycheck. Recurring payroll deductions are deducted once per pay period.