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We would love to hear from you! Please fill out this form and we will get in touch with you shortly.

First Name*
Last Name*
Company/Location*
Email*
I hereby authorize Paul Miller Ford, Inc. to deduct the following amount from my paycheck each pay period for contribution to Stars Helping Stars, Inc.:*
Enter Dollar Amount IF you choose 'Other' in the option above.
- I understand that my donation to this fund will begin with the first pay period after this authorization form has been processed and will be used for assistance to Paul Miller Ford, Inc. STARS in need and in accordance with established guidelines of the program. The deduction will be made each pay period and will continue until revoked or revised by me in writing. In the event that I miss a contribution due to lack of earnings in a pay period, that contribution will NOT be deducted from a future paycheck.
If you would like to discontinue your STARS Helping STARS contributions, please select the option below instead:
- I revoke my prior election and choose to stop my payroll deduction at this time.
Signature*
Date*
By submitting this form, you consent to receive communications, including calls, texts, or emails, that may be generated using automated technology or AI systems. These communications are intended to provide information about your inquiry or to schedule appointments. Standard message and data rates may apply. Consent to these communications is not a condition of purchase. Message frequency varies. Reply HELP for help. To opt-out of such communications, please contact us directly or reply with ‘STOP’ to any message. Your mobile information will not be sold or shared with third parties for promotional or marketing purposes.
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Stars Helping Stars Contribute

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