FIRST STATE BANK Employer Name Preferred Donation Method First Name Employer Options - Select One - Select -Payroll Deduction Check My Contact Information Last Name Amount Per Pay Period Home Address Location/Department Name Frequency you are Paid - None -Bi-Weekly (22 times/yr) Donor Notes City State - None -Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code Amount of Check Email Address Office Phone Cell Phone County Designation - Select -Cooke Wise Denton Grayson Cooke County - Chisholm Trail Club Members - None -Wagon Driver $500-$999 Wagon Master $1,000-$1,999 Scout $2,000 and up Denton County - Pillar Givers - None -Platinum Pillar $1,000-$2,499 Capstone Pillar $2,500-$4,999 Grayson County - Circle of Giving - None -Ben Blackburn Circle of Honor $10,000+ Grayson Circle $5000 to $9999 Gold Circle $2500 to $4999 Silver Circle $1000 to $2499 Bronze Circle $500 to $999 Wise County - Major Donors - None -Bronze $1,000-$2,999 Silver $3,000-$9,999 Submit
