Fillable Pledge Form Salt River Community Childrens Foundation (Salt River Pima-Maricopa Indian Community)

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Pledge Form Salt River Community Childrens Foundation (Salt River Pima-Maricopa Indian Community)

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The Pledge Form Salt River Community Childrens Foundation (Salt River Pima-Maricopa Indian Community) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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Pledge Form
Salt River Community Children’s Foundation
A Foundation of the Salt River Pima-Maricopa Indian Community
Office: (480) 362-5711
Email:
srcf@srpmic-nsn.gov
Srccfoundation.org
Donor Information (please print or type)
Name
Billing address
City
State
ZIP Code
Telephone
Telephone (alt.)
Department
E-Mail
Pledge Information
Automatic Payroll Deduction
$5 $10 $15 $20 Other
Check
Check #
Charge a one-time deduction
Amount $
Employee Signature
Printed Employee Name
I wish to remain an anonymous donor.
Acknowledgement Information
By signing, I hereby authorize the Salt River Pima-Maricopa Indian Community Payroll Office to make an
automatic payroll deduction, in the amount specified above, to the Salt River Community Children’s
Foundation (SRCCF). Furthermore, I understand that I may amend or cancel this automatic payroll
deduction at any time by providing a written statement to the Payroll Office asserting the desired changes:
Signature(s)
Date
Please make checks, corporate matches, or other gifts payable to:
Salt River Community Children’s Foundation
10,0005 E. Osborn
Scottsdale, AZ 85256
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Pledge Form Salt River Community Childrens Foundation (Salt River Pima-Maricopa Indian Community)

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Completed 20 July 2020

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