Full name *

Email address

Cell phone *

(+)

Schedule pay day

Day of the month

Redemption method*

Select Option Cash M-Pesa Cheque Bank Transfer In Kind/Other

Redemption type*

Select Option Weekly Monthly Quarterly Yearly Bi-annually Random

Reminder *

Select Option 1 Week 2 Weeks 4 Weeks Do not remind me Before my due date

Reminder type*

Select Option SMS Email Phone Call

---

Year1*

Amount*

Year2

Amount

Year3

Amount

---

Let my gift remain anonymous? *

Select Option Yes No

---

Cancel