GIVE TO ENABLE SUPPORT PROGRAM - DONOR FORM

This Donor Form is to donate to the Give to Enable Support Cash Fund. To donate to an individual's Enable account, go to their Member page.

The Give to Enable Support Cash Fund (the “Fund”) provides funding to the Give to Enable Support Program (the “Program”). Contributions to the Fund are used to help fund initial contributions to help Enable-eligible individuals open an Enable Account under the Program. Donations to the Fund cannot be earmarked for an individual Enable account and are allocated to Program participants on a first-come-first-served basis.

Please see the Give to Enable Support Program Rules (opens in a new tab) for more information.

Alternatively, this form may be printed, completed and mailed.

Required fields are denoted with an asterisk.*

Tax ID/SSN*: Required Invalid Characters

First Name*: Required Invalid Characters

Last Name*: Required Invalid Characters

First and Last Name*:

Company Name: Invalid Characters

Email Address*: Required Invalid Email Address

Amount*: Required Invalid Characters

Payment Method*: Check
Electronic Withdrawal

Mail check to:

GIVE TO ENABLE SUPPORT PROGRAM
STATE CAPITOL, ROOM 2005
PO BOX 94788
LINCOLN NE 68509-4788

(Please include a printed copy of this completed form so your check payment is associated with your application.)

Please enter electronic payment information.

If Electronic Withdrawal selected, please provide the following:

Routing: Required Invalid Routing

Account: Required Invalid Account

Checking or Savings? Checking
Savings Required

Personal or Business Account? Personal
Business Required

Please agree to the following:

You authorize the Nebraska State Treasurer to debit the bank account provided, within 3 banking days of this authorization.

Electronic Check Re-presentment Policy – In the event that your check is returned unpaid for insufficient or uncollected funds, we may re-present your check electronically. In the ordinary course of business, your check will not be provided to you with your bank statement, but a copy can be retrieved by contacting your financial institution.

A returned payment fee of $25 will be charged on all returned checks and ACH debits.

I understand my contribution to the Give to Enable Support Cash Fund will be used to fund the Give to Enable Support Program – the Program provides initial contributions to help open Enable Accounts for Enable-eligible individuals who do not already have an Enable Account. Donations will be allocated to Program participants on a first-come-first-served basis and are not earmarked for any individual Enable Account Owner.

Mail completed form to: GIVE TO ENABLE SUPPORT PROGRAM

STATE CAPITOL, ROOM 2005

PO BOX 94788

LINCOLN NE 68509-4788