Benefit Pledge Form Print blank form to mail in. Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* two ways to giveMY SINGLE GIFT ISSelect a payment option: Check will be mailed Contact me about a special gift (i.e. stocks) MY ONGOING MONTHLY GIFT IS:Select a payment option: ACH from Checking (I will mail voided check or contact Nancy, bookkeeper, with account information) I will mail my monthly check I already have an ongoing monthly pledge: Continue my current pledge of: Change the amount of my current pledge to Please include any questions or special circumstances you want to bring to the attention of our bookkeeper.Monthly Authorization:* Monthly Authorization:Please transfer my monthly gift from my account on the 15th of each month (beginning with October 15, 2020) until further notice from me. I understand this agreement is the same as signing a check each month, and I may change it at any time by contacting Little Way.