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Then save, print and fill-out the pledge form.

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Instructions

1. Complete all portions of the form, including your complete name, federal agency or organization name, unit/division or payroll office, work address, work phone and social security number or Employee ID # (payroll deduction, only)
2. If you are pledging a gift through payroll deduction, write in the amount to be deducted each pay period.
3. Indicate the agency/charity five-digit code number that you wish to donate.
4. Indicate the annual dollar amount for each agency selected. The total dollars should not exceed your total pledge.
5. Indicate if you wish to receive an acknowledgement from your designated agencies. If so, provide your home address and/or email address.
6. Sign and date to authorize release of this information to the agency and/or your payroll office.